Clinical Practice and Cases in Emergency Medicine

Introduction: Patients with history of abdominal aortic aneurysm (AAA) undergoing surgical repair can have a myriad of surgical complications including compromise to large arteries branching from the aorta. Secondary hyperaldosteronism, characterized by high levels of aldosterone and renin, can be due to a multitude of causes, including renal artery stenosis, and presents with nonspecific symptoms of fatigue, increased thirst, and muscle spasms. While it can initially be difficult to diagnose given its multitude of metabolic abnormalities, secondary hyperaldosteronism is important to consider in patients presenting with uncontrolled hypertension, hypokalemia, and metabolic alkalosis.

Case Report: This report explores the case of a 65-year-old male with a complicated medical history presenting to the emergency department with hypokalemia and hypertension six months after undergoing endovascular repair for an AAA and was found to have metabolic abnormalities including hypokalemia and metabolic alkalosis consistent with secondary hyperaldosteronism, likely secondary to renal artery stent stenosis. He was admitted to the hospital for four days and made a full recovery.

Conclusion: This case highlights the need to understand, identify, and accurately diagnose hyperaldosteronism and recognize post-AAA repair complications of renal artery stenosis as a cause of this metabolic derangement.