A case of acute psychotic episode at the onset of primary aldosteronism

Primary aldosteronism (PA) is a common cause of secondary hypertension. Moreover, the spectrum of clinical manifestations of PA may involve a more extensive continuum and different clinical manifestations, including also neuropsychiatric symptoms. Until now, there have been only a few reports of psychiatric symptoms in patients with PA. Here, we describe a case of PA presenting with an acute psychotic episode. A 55-year-old Asian woman with no pathological history was admitted to the emergency room because of altered mental status with confusion and agitation, recurrent speech, and unmotivated laughter lasting for approximately 36 hours. The clinical manifestation was initially considered psychiatric and treated with olanzapine and lorazepam. She presented as hypertensive. The laboratory showed hypokalemia. PA was suspected and then confirmed by a saline infusion and captopril test. An abdominal computed tomography scan showed a left adrenal cortical adenoma. Significant left lateralization at adrenal vein sampling was obtained. We suggest considering PA in the differential diagnosis of hypertensive patients with psychiatric manifestations.