Tohoku J. Exp. Med., 2019 May, 248(1)

Improvement of Cardiac Function by Laparoscopic Adrenalectomy in a Patient with Severe Heart Failure Attributable to Primary Aldosteronism

SHIN SATO,¹ YOSHIHIDE KAWASAKI,¹ AKIHIRO ITO,¹ RYO MORIMOTO,² SHUICHI SHIMADA,¹ TAKUMA SATO,¹ HIDEAKI IZUMI,¹ NAOKI KAWAMORITA,¹ SHINICHI YAMASHITA,¹ KOJI MITSUZUKA¹ and YOICHI ARAI¹

¹Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

Aldosterone affects various systems and organs, including the cardiovascular system, through mineralocorticoid receptors. We here report a primary aldosteronism patient with severe cardiac dysfunction who showed dramatic improvement after laparoscopic adrenalectomy. The 57-year-old man presented with acute heart failure exacerbation. Performance status was 4, and New York Heart Association classification was 4. Echocardiography showed diffuse hypokinetic wall motion with an ejection fraction of 20%. The patient was found to have a high plasma level of brain natriuretic peptide (4,935 pg/mL), hypokalemia (2.7 mEq/L), an extremely elevated plasma aldosterone concentration (1,804 pg/mL), and high aldosterone-to-renin ratio [plasma aldosterone concentration (pg/mL)/plasma renin activity (ng/mL/hr)] (9,002). Computed tomography revealed a tumor 42 mm in diameter in the right adrenal gland. Primary aldosteronism was diagnosed with adrenal venous sampling. Medical treatment for heart failure was continued for several months, but the cardiac function was not sufficiently improved, suggesting the indication of heart transplantation. However, the patient could not be considered a candidate because of the adrenal tumor. Laparoscopic adrenalectomy was therefore performed. Immediately after surgery, echocardiography showed improved wall motion with an ejection fraction of 36%. Performance status and New York Heart Association classification were improved to 0 and 2, respectively. The present case has shown the efficacy of laparoscopic adrenalectomy for primary aldosteronism patients with severe heart failure.

keywords —— ejection fraction; heart failure; laparoscopic adrenalectomy; mineralocorticoid receptor; primary aldosteronism

© 2019 Tohoku University Medical Press

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ohoku J. Exp. Med., 2019, 248, 31-36

Correspondence: Yoshihide Kawasaki, Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: kawasaki@uro.med.tohoku.ac.jp