An Adrenal Adenoma as the Culprit Behind 30 Years of Recurrent Syncope

Primary aldosteronism (PA) is a treatable endocrine cause of secondary hypertension and, rarely, ventricular tachycardia (VT), syncope, or sudden cardiac death.

A 59-year-old woman with hypertension presented with recurrent syncope for 30 years, worsening over 2 weeks. Electrocardiogram showed multifocal premature ventricular complexes (PVCs), with one dominant morphology triggering predominantly monomorphic VT, plus corrected QT interval prolongation. Hypokalemia, renal potassium wasting, left ventricular enlargement, and mild systolic dysfunction were also present. Ventricular arrhythmias recurred despite electrolyte repletion, beta-blocker therapy, and radiofrequency catheter ablation. A positive saline infusion test and a 3.6-cm left adrenal adenoma supported PA. After adrenalectomy, potassium normalized, palpitations improved, VT burden decreased, and syncope did not recur at 1 month.

PA may present primarily with ventricular arrhythmias and syncope. In patients with ventricular arrhythmias accompanied by hypertension and hypokalemia, PA should be considered as a treatable endocrine-metabolic cause.