Resolution of ventricular dysfunction and fibrosis in a young woman with primary hyperaldosteronism

A 25-year-old female was admitted to hospital due to a hypertensive crisis, presenting with ventricular dysfunction and renal impairment. Initial evaluations revealed a left ventricular ejection fraction of 46% with baseline inferolateral intramyocardial enhancement and a creatinine clearance of 45mL/min/1.73m², with proteinuria. Further investigations led to diagnosis of primary hyperaldosteronism (PA), with computed tomography demonstrating bilateral adrenal hyperplasia. After a nine-month treatment period with spironolactone, there was a complete reversal of ventricular dysfunction and fibrosis, and improvement in renal function. This case highlights the importance of early screening and appropriate treatment of PA to mitigate and potentially reverse end-organ damage.