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Systolic heart failure in a patient with primary aldosteronism
  1. Chikezie Alvarez1,
  2. Vinuta Mohan2
  1. 1 Internal Medicine, St. Francis Medical Center, Trenton, New Jersey, USA
  2. 2 Endocrinology, St. Francis Medical Center, Trenton, New Jersey, USA
  1. Correspondence to Dr Chikezie Alvarez, chikeziealvarez{at}


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.

  • heart failure
  • hypertension
  • adrenal disorders
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  • Contributors CA drafted the manuscript, obtained the images and revised the manuscript. VM also made critical revisions to the manuscript and also contributed to drafting, editing and final revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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