Curable congestive heart failure in patients with primary aldosteronism: two cases reports

Primary aldosteronism (PA) is characterized by overproduction of aldosterone which can lead to various target organ damage, including the cardiovascular system. There are rare case reports about PA patients with severe heart failure. We report two male patients who were admitted because of severe cardiac systolic dysfunction induced by primary aldosteronism. Their cardiac function improved significantly after target therapy. Patient A was a 33 year old male with serum aldosterone concentration (PAC) 251.3 pg/ml, renin activity (PRA) 0.04 ng/ml/h, and aldosterone-to-renin ratio (ARR) 627.5. Computed tomography (CT) revealed a tumor in the left adrenal gland, while no dominant secretion function was found in the left side after the adrenal veins sampling (lateralization index 0.99). Bilateral adrenal hyperplasia was diagnosed and spironolactone was prescribed. Left ventricular ejection fraction (LVEF) was improved from 30% to 45% at the 11-month follow-up visit. Patient B was 43 years old male with PAC 185.5 pg/ml, PRA 0.46 ng/ml/h and ARR 403.2; Captopril challenge test was positive and a microadenoma (2.7*3.2*2.8 cm) was revealed on CT. Unilateral aldosterone-producing adenoma was diagnosed. His LVEF was improved from 30% to 51% at 12 months after laparoscopic adrenalectomy. Thus, it is important to screen for PA in patients with heart failure and launch the appropriate treatment for such patients.