Systolic heart failure in a patient with primary aldosteronism

Abstract

A 53-year-old African man with a 25-year history of uncontrolled hypertension and systolic heart failure presented with an acute congestive heart failure exacerbation. He was found to have severe hypokalaemia, so additional testing was performed, and primary aldosteronism was confirmed. CT scan showed a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland. Adrenal vein sampling confirmed unilateral primary aldosteronism with lateralisation to the left adrenal gland. The patient was started on spironolactone and was referred to surgery for laparoscopic left adrenalectomy. Primary aldosteronism is associated with high cardiovascular morbidity and mortality due to activation of cardiac mineralocorticoid receptors. Studies suggest these negative effects can be reduced with early intervention and treatment. This case highlights the importance of investigating secondary causes of hypertension in young patients and the potential adverse cardiac effects of primary aldosteronism when it goes undiagnosed and untreated for years.

Keywords: adrenal disorders; heart failure; hypertension.

Figure 1

Sagittal view of cardiac MRI revealing marked concentric left ventricular hypertrophy with areas of delayed myocardial enhancement representing fibrosis related to hypertrophy and in a distribution atypical for ischaemic disease/prior infarct and atypical for amyloidosis.

Figure 2

Coronal view of CT abdomen/pelvis with contrast showing a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland with rapid enhancement and washout of contrast.

Figure 3

Axial view of CT abdomen/pelvis with contrast showing a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland with rapid enhancement and washout of contrast.