Abstract
BackgroundPrimary aldosteronism (PA) increases the risk of cardiovascular morbidity, including stroke, coronary artery disease, atrial fibrillation, and heart failure. The relationship between primary aldosteronism and aortic dissection has rarely been reported. We report a case of aortic dissection caused by secondary hypertension from PA and review similar cases in the literature.Case presentationA 56-year-old woman with a history of surgery for aortic dissection presented for follow-up of hypertension and a left adrenal mass. She had been diagnosed with hypertension and hypokalemia in 2003. Blood pressure had been controlled by antihypertensive medications. In 2009, she presented with chest and back pain; she was diagnosed with aortic dissection by computed tomography (CT). She underwent placement of an endovascular aortic stent graft. CT at that time showed a left adrenal mass with a diameter of 1 cm. In 2017, CT reexamination revealed that the left adrenal mass had grown to 3 cm in diameter. Laboratory data showed blood potassium 2.4 mmol/L (reference range: 3.5–5.3 mmol/L). The plasma aldosterone/renin ratio was elevated because of suppressed plasma renin and elevated serum aldosterone levels. Plasma aldosterone levels were not suppressed after taking captopril. Positron emission tomography/CT showed that the left adrenal tumor radiographic uptake was slightly increased (maximum standardized uptake value of 2.2), and metastasis was not detected. Laparoscopic adrenalectomy was performed, and an adrenocortical adenoma was confirmed histopathologically. After surgery, blood pressure and laboratory findings were within their reference ranges without any pharmacological treatment.ConclusionsOur patient and the literature suggest that PA is a potential cause of aortic dissection. Diagnosing PA in the early stages of the disease and early treatment are important because affected patients may be at increased risk of aortic dissection.
Highlights
Primary aldosteronism (PA) increases the risk of cardiovascular morbidity, including stroke, coronary artery disease, atrial fibrillation, and heart failure
Our patient and the literature suggest that PA is a potential cause of aortic dissection
Diagnosing PA in the early stages of the disease and early treatment are important because affected patients may be at increased risk of aortic dissection
Summary
Primary aldosteronism (PA) is a group of disorders in which aldosterone production is inappropriately high [1]. Case presentation A 56-year-old woman presented to our hospital with a history of a left adrenal mass and high blood pressure. She had been diagnosed with hypertension in 2003. She was found to have a left adrenal mass approximately 1 cm in diameter She was started on valsartan to reduce blood pressure. CT of the abdomen showed that the left adrenal mass had grown to more than 3 cm in diameter (Fig. 2) She was investigated further in our hospital. Despite initial good control of hypertension, blood pressures rose again and after 8 m of medical treatment, the patient elected to undergo left laparoscopic adrenalectomy. The postoperative course was uneventful, and the patient’s blood pressure and serum potassium remained normal without medication
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