Cargando…

Cardiovascular Remodeling in Chronic Mineralocorticoid Excess

Primary hyperaldosteronism typically leads to resistant hypertension, hypokalemia, and metabolic alkalosis. Excess aldosterone secretion by the adrenal glands may lead to heart failure with preserved ejection fraction. Potassium-sparing diuretics and aldosterone antagonists directed to lower excess...

Descripción completa

Detalles Bibliográficos
Autores principales: Bhattad, Pradnya Brijmohan, Roumia, Mazen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10361634/
https://www.ncbi.nlm.nih.gov/pubmed/37485117
http://dx.doi.org/10.7759/cureus.40753
_version_ 1785076258969747456
author Bhattad, Pradnya Brijmohan
Roumia, Mazen
author_facet Bhattad, Pradnya Brijmohan
Roumia, Mazen
author_sort Bhattad, Pradnya Brijmohan
collection PubMed
description Primary hyperaldosteronism typically leads to resistant hypertension, hypokalemia, and metabolic alkalosis. Excess aldosterone secretion by the adrenal glands may lead to heart failure with preserved ejection fraction. Potassium-sparing diuretics and aldosterone antagonists directed to lower excess aldosterone levels may help treat the associated heart failure and lead to control of blood pressure, resulting in improved outcomes. We report a case of a 55-year-old male with poorly controlled hypertension and newly symptomatic heart failure with preserved ejection fraction in the setting of excess aldosterone activity and an adrenal adenoma suggesting primary aldosteronism-induced diastolic heart failure. The biochemical evaluation revealed elevated plasma aldosterone concentrations with low plasma renin activity, diuretic-induced hypokalemia, and metabolic alkalosis. A progressively enlarging left adrenal adenoma was found on abdominal imaging along with resistant hypertension despite the use of multiple antihypertensive medications. Medical management targeted to lower excess aldosterone levels with the use of aldosterone antagonists helped us achieve better blood pressure control and resolution of symptoms of diastolic dysfunction. Treating the underlying pathology helped us improve overt heart failure and may suggest that goal-directed therapy towards the inciting factors may potentially lead to a path to reverse the heart failure symptoms clinically.
format Online
Article
Text
id pubmed-10361634
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-103616342023-07-22 Cardiovascular Remodeling in Chronic Mineralocorticoid Excess Bhattad, Pradnya Brijmohan Roumia, Mazen Cureus Cardiology Primary hyperaldosteronism typically leads to resistant hypertension, hypokalemia, and metabolic alkalosis. Excess aldosterone secretion by the adrenal glands may lead to heart failure with preserved ejection fraction. Potassium-sparing diuretics and aldosterone antagonists directed to lower excess aldosterone levels may help treat the associated heart failure and lead to control of blood pressure, resulting in improved outcomes. We report a case of a 55-year-old male with poorly controlled hypertension and newly symptomatic heart failure with preserved ejection fraction in the setting of excess aldosterone activity and an adrenal adenoma suggesting primary aldosteronism-induced diastolic heart failure. The biochemical evaluation revealed elevated plasma aldosterone concentrations with low plasma renin activity, diuretic-induced hypokalemia, and metabolic alkalosis. A progressively enlarging left adrenal adenoma was found on abdominal imaging along with resistant hypertension despite the use of multiple antihypertensive medications. Medical management targeted to lower excess aldosterone levels with the use of aldosterone antagonists helped us achieve better blood pressure control and resolution of symptoms of diastolic dysfunction. Treating the underlying pathology helped us improve overt heart failure and may suggest that goal-directed therapy towards the inciting factors may potentially lead to a path to reverse the heart failure symptoms clinically. Cureus 2023-06-21 /pmc/articles/PMC10361634/ /pubmed/37485117 http://dx.doi.org/10.7759/cureus.40753 Text en Copyright © 2023, Bhattad et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Bhattad, Pradnya Brijmohan
Roumia, Mazen
Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title_full Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title_fullStr Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title_full_unstemmed Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title_short Cardiovascular Remodeling in Chronic Mineralocorticoid Excess
title_sort cardiovascular remodeling in chronic mineralocorticoid excess
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10361634/
https://www.ncbi.nlm.nih.gov/pubmed/37485117
http://dx.doi.org/10.7759/cureus.40753
work_keys_str_mv AT bhattadpradnyabrijmohan cardiovascularremodelinginchronicmineralocorticoidexcess
AT roumiamazen cardiovascularremodelinginchronicmineralocorticoidexcess