Aldosterone affects various systems and organs, including the cardiovascular system, through
mineralocorticoid receptors. We here report a primary
aldosteronism patient with severe cardiac dysfunction who showed dramatic improvement after laparoscopic
adrenalectomy. The 57-year-old man presented with acute
heart failure exacerbation. Performance status was 4, and New York Heart Association classification was 4. Echocardiography showed diffuse hypokinetic wall motion with an ejection fraction of 20%. The patient was found to have a high plasma level of
brain natriuretic peptide (4,935 pg/mL),
hypokalemia (2.7 mEq/L), an extremely elevated plasma
aldosterone concentration (1,804 pg/mL), and high
aldosterone-to-
renin ratio [plasma
aldosterone concentration (pg/mL)/plasma
renin activity (ng/mL/hr)] (9,002). Computed tomography revealed a
tumor 42 mm in diameter in the right adrenal gland. Primary
aldosteronism was diagnosed with adrenal venous sampling. Medical treatment for
heart failure was continued for several months, but the cardiac function was not sufficiently improved, suggesting the indication of
heart transplantation. However, the patient could not be considered a candidate because of the adrenal
tumor. Laparoscopic
adrenalectomy was therefore performed. Immediately after surgery, echocardiography showed improved wall motion with an ejection fraction of 36%. Performance status and New York Heart Association classification were improved to 0 and 2, respectively. The present case has shown the efficacy of laparoscopic
adrenalectomy for primary
aldosteronism patients with severe
heart failure.