Acute decompensated heart failure in a patient with primary aldosteronism successfully treated with an adrenalectomy: A case report

      Abstract

      Primary aldosteronism is often associated with heart failure (HF), and is reportedly difficult to treat in some cases. We report a case of severe HF associated with primary aldosteronism. A patient with HF, who was suspected of having primary aldosteronism, was referred to and examined at our hospital. After detailed examination, the patient was diagnosed with exacerbation of HF, and was treated at our department. Catheterization after admission revealed Forrester class IV HF. The patient was treated with catecholamine infusion in combination with medical treatment including mineralocorticoid receptor antagonists. The patient was diagnosed with hypertension due to primary aldosteronism and intractable secondary HF with increased peripheral vascular resistance. An open adrenalectomy was successfully performed under intra-aortic balloon pumping. Right heart catheterization, performed soon thereafter, demonstrated improvement in the patient's blood pressure and hemodynamics. We speculate that the improved cardiac function resulted from a reduction in the vascular resistance, as a consequence of the adrenalectomy.

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      References

        • Omura M.
        • Saito J.
        • Yamaguchi K.
        • Kakuta Y.
        • Nishikawa T.
        Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan.
        Hypertens Res. 2004; 27: 193-202
        • Ohno Y.
        • Sone M.
        • Inagaki N.
        • Yamasaki T.
        • Ogawa O.
        • Takeda Y.
        • Kurihara I.
        • Itoh H.
        • Umakoshi H.
        • Tsuiki M.
        • Ichijo T.
        • Katabami T.
        • Tanaka Y.
        • Wada N.
        • Shibayama Y.
        • et al.
        Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan.
        Hypertension. 2018; 71: 530-537
        • Born-Frontsberg E.
        • Reincke M.
        • Rump L.C.
        • Hahner S.
        • Diederich S.
        • Lorenz R.
        • et al.
        Participants of the German Conn’s Registry. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s registry.
        J Clin Endocrinol Metab. 2009; 94: 1125-1130
        • Morimoto S.
        • Takeda R.
        • Murakami M.
        Does prolonged pretreatment with large doses of spironolactone hasten a recovery from juxtaglomerular-adrenal suppression in primary aldosteronism?.
        J Clin Endocrinol Metab. 1970; 31: 659-664
        • Reincke M.
        • Fischer E.
        • Gerum S.
        • Merkle K.
        • Schulz S.
        • Pallauf A.
        • Quinkler M.
        • Hanslik G.
        • Lang K.
        • Hahner S.
        • Allolio B.
        • Meisinger C.
        • Holle R.
        • Beuschlein F.
        • Bidlingmaier M.
        • et al.
        Observational study mortality in treated primary aldosteronism: the German Conn’s registry.
        Hypertension. 2012; 60: 618-624
        • Weber K.T.
        • Janicki J.S.
        • Pick R.
        • Capasso J.
        • Anversa P.
        Myocardial fibrosis and pathologic hypertrophy in the rat with renovascular hypertension.
        Am J Cardiol. 1990; 65: 1G-7G
        • Nguyen Dinh Ca.t A.
        • Griol-Charhbili V.
        • Loufrani L.
        • Labat C.
        • Benjamin L.
        • Farman N.
        • Lacolley P.
        • Henrion D.
        • Jaisser F.
        The endothelial mineralocorticoid receptor regulates vasoconstrictor tone and blood pressure.
        FASEB J. 2010; 24: 2454-2463
        • Pitt B.
        • Remme W.
        • Zannad F.
        • Neaton J.
        • Martinez F.
        • Roniker B.
        • Bittman R.
        • Hurley S.
        • Kleiman J.
        • Gatlin M.
        Eplerenone post-acute myocardial infarction heart failure efficacy and survival study investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.
        N Engl J Med. 2003; 348: 1309-1321
        • Yasuoka S.
        • Kai H.
        • Kajimoto H.
        • Kudo H.
        • Takayama N.
        • Anegawa T.
        • Koga M.
        • Miyamoto T.
        • Mifune H.
        • Kage M.
        • Hirooka Y.
        • Imaizumi T.
        Blood pressure variability activates cardiac mineralocorticoid receptor and induces cardiac remodeling in hypertensive rats.
        Circ J. 2013; 77: 1474-1481
        • Sato S.
        • Kawasaki Y.
        • Ito A.
        • Morimoto R.
        • Shimada S.
        • Sato T.
        • Izumi H.
        • Kawamorita N.
        • Yamashita S.
        • Mitsuzuka K.
        • Arai Y.
        Improvement of cardiac function by laparoscopic adrenalectomy in a patient with severe heart failure attributable to primary aldosteronism.
        Tohoku J Exp Med. 2019; 248: 31-36