(251) Acute Cardiac Event as Initial Presentation of Primary Hyperaldosteronism: A Rare Event

Introduction: Primary Hyperaldosteronism accounts for 1 in 5 cases of treatment-resistant hypertension. Hyperaldosteronism, a condition characterized by increased aldosterone production, is of two types. Primary Hyperaldosteronism results from conditions such as adrenal hyperplasia or adenomas. Adenomas are common in women, with an increased prevalence in African Americans. We present a case of primary Hyperaldosteronism caused by adrenal adenoma. The rationale for case selection is the severely acute rapid deterioration with a cardiac event in an otherwise healthy female ultimately needing lifesaving measures, an extremely rare initial presentation mode.

Description: A 56-year-old female with a history of hypertension presented to the ER with complaints of chest pain for 6 hours. On exam, BP was 248/108, EKG showed junctional rhythm, & progressed to ventricular fibrillation. The patient coded in ER needing CPR & revived. Metabolic Panel revealed potassium of 1.1 & lactate of 11—rest of the blood work including CBC, ABGs. TSH, CK, and BNP were unremarkable. A probable diagnosis of acute coronary syndrome was made, & patient was started on aspirin, antiarrhythmics, anticoagulants, and potassium replacement and transferred to Cardiac Intensive Care. The coronary workup was unremarkable. The abdomen and pelvis CT scan showed a 2.2 cm left adrenal adenoma. The patient underwent robotic adrenalectomy, was discharged home on a tapering dose of steroids, and had a 4-week follow-up in endocrinology.

Discussion: Primary Hyperaldosteronism presents a classic triad of treatment-resistant hypertension, hypokalemia, and alkalosis. It is an uncommon clinical condition that can be frequently missed. Evidence suggests that high aldosterone concentrations have a deleterious effect on cardiovascular tissues leading to organ damage, as demonstrated in our case. A high index of suspicion for primary Hyperaldosteronism is needed when evaluating treatment-resistant hypertension and hypokalemia, hypertension at a young age, or when investigating secondary hypertension as it is an underdiagnosed cause of hypertension with life-threatening consequences if missed.