Primary
aldosteronism (PA) has been recognized as a relatively benign form of
hypertension associated with a low incidence of vascular complications. Recent reports, however, indicate that
cerebrovascular accidents are common in PA. We report a case of multiple
aneurysms with PA in a middle-aged woman who presented with
subarachnoid hemorrhage. A 47-year-old woman with a history of untreated
hypertension was referred to our hospital for
subarachnoid hemorrhage. Cerebral angiography showed multiple small
aneurysms. The initial intervention was
aneurysm clipping for a
ruptured aneurysm at the bifurcation of the right middle cerebral artery. Despite medication, she continued to suffer from uncontrolled
hypertension and
hypokalemia. She was diagnosed with PA on the basis of elevated plasma
aldosterone, suppressed plasma
rennin, and a right adrenal
tumor detected by abdominal CT scanning. She underwent several more neck clippings for the remaining
aneurysms (unruptured), followed by a total right adrenectomy. Histological examination revealed an adrenal
adenoma. After the operation, her blood pressure returned to normal without any vasodepressors. Recent studies have demonstrated that
hyperaldosteronism might have direct vasculo-
toxic actions, including remodeling,
fibrosis, and proliferation.
Cerebrovascular accidents caused by PA are reported to have high rates of mortality and recurrence when the PA is overlooked or untreated. Physicians must be alert to the possibility of PA in patients with
hypertension and persistent
hypokalemia, especially in those who are young or middle-aged. We also recommend screening for
intracranial aneurysms by low-invasive magnetic resonance angiography.