Improvement of Cardiac Function by Laparoscopic Adrenalectomy in a Patient with Severe Heart Failure Attributable to Primary Aldosteronism
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- Sato Shin
- Department of Urology, Tohoku University Graduate School of Medicine
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- Kawasaki Yoshihide
- Department of Urology, Tohoku University Graduate School of Medicine
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- Ito Akihiro
- Department of Urology, Tohoku University Graduate School of Medicine
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- Morimoto Ryo
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine
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- Shimada Shuichi
- Department of Urology, Tohoku University Graduate School of Medicine
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- Sato Takuma
- Department of Urology, Tohoku University Graduate School of Medicine
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- Izumi Hideaki
- Department of Urology, Tohoku University Graduate School of Medicine
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- Kawamorita Naoki
- Department of Urology, Tohoku University Graduate School of Medicine
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- Yamashita Shinichi
- Department of Urology, Tohoku University Graduate School of Medicine
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- Mitsuzuka Koji
- Department of Urology, Tohoku University Graduate School of Medicine
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- Arai Yoichi
- Department of Urology, Tohoku University Graduate School of Medicine
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Description
<p>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.</p>
Journal
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- The Tohoku Journal of Experimental Medicine
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The Tohoku Journal of Experimental Medicine 248 (1), 31-36, 2019
Tohoku University Medical Press