原発性アルドステロン症による大動脈解離：症例報告

BACKGROUND Primary aldosteronism (PA) is the most common cause of endocrine-related secondary hypertension, accounting for up to 10% of hypertensive cases in specialized centers. It is associated with increased risks of cardiovascular events, target organ damage, and metabolic complications. However, PA is often underdiagnosed due to its subtle or atypical clinical manifestations. In particular, young patients presenting with severe or resistant hypertension should prompt a thorough evaluation for secondary causes. One of the most concerning but underrecognized consequences of PA is its potential association with vascular abnormalities, including aortic dissection, which can be fatal if not promptly addressed. CASE REPORT We present the case of a 36-year-old man who was admitted with poorly controlled hypertension and gingival hyperplasia. Imaging studies revealed a descending aortic dissection. Laboratory investigations showed persistent hypokalemia, suppressed plasma renin activity, and markedly elevated plasma aldosterone concentration, all indicative of PA. Contrast-enhanced abdominal computed tomography (CT) identified a hypodense mass in the right adrenal gland, consistent with an adrenal cortical adenoma. The patient underwent successful laparoscopic right adrenalectomy. Postoperatively, his blood pressure and serum potassium levels normalized, and symptoms of gingival hyperplasia improved significantly. CONCLUSIONS This case underscores the importance of early screening for secondary hypertension, especially in younger individuals with severe clinical presentations. PA can lead to life-threatening complications such as aortic dissection if left undiagnosed and untreated. Clinicians should maintain a high index of suspicion for PA in similar cases. Timely diagnosis and surgical intervention can significantly improve patient prognosis and prevent catastrophic vascular events.