Fibrillation atriale révélatrice d’un hyperaldostéronisme primaire : à propos d’un cas

Abstract

Primary hyperaldosteronism is the most common cause of secondary hypertension, with a prevalence estimated between 5% and 15%. Despite this, it remains largely underdiagnosed due to often non-specific clinical manifestations and insufficient screening. However, primary hyperaldosteronism is associated with significantly higher cardiovascular morbidity and mortality compared to essential hypertension, regardless of blood pressure levels and usual cardiac remodeling. Recent studies have highlighted a direct link between primary hyperaldosteronism and atrial fibrillation-the most common sustained arrhythmia in adults-associated with increased cardiovascular risk. This connection is partly explained by the direct involvement of the renin-angiotensin-aldosterone system in the pathophysiology of this arrhythmia. We report the case of a patient with moderate hypertension, persistent hypokalemia, and unexplained atrial fibrillation. The absence of hemodynamic impact on echocardiography and the exclusion of classical etiologies of atrial fibrillation led to the suspicion of primary hyperaldosteronism. Hormonal testing confirmed the diagnosis of primary hyperaldosteronism due to a Conn's adenoma. A laparoscopic adrenalectomy was performed, with favorable outcomes. This case highlights the often underestimated association between primary hyperaldosteronism and atrial fibrillation, and emphasizes the importance of targeted screening in hypertensive patients with unexplained atrial fibrillation, to optimize management and improve cardiovascular prognosis.

Keywords: Adrenal adenoma; Arterial hypertension; Atrial fibrillation; Primary hyperaldosteronism.