Coronary Artery Aneurysms, Aortic Dissection, and Hypertension Secondary to Primary Aldosteronism: A Rare Triad

Abstract

Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.

Is primary aldosteronism a potential risk factor for aortic dissection? A case report and literature review

“…The results were limited to full-text articles published in English. Seven available reports were included in the review [14][15][16][17][18][19][20] (Table 3). The PA features of these patients are summarized as follows: In the PA subtype classification, five patients had adrenal adenoma, one patient had nodular cortical hyperplasia, and one patient had glucocorticoidremediable aldosteronism.…”

Is Primary Hyperaldosteronism a Risk Factor for Aortic Dissection?

“…In addition, his hypertension was relatively well controlled and there was no other obvious cause for his aortic dissection. To our knowledge, there are six other reported cases of aortic dissection in patients with primary hyperaldosteronism [5,6,7,8]. These include a case of unilateral adrenal hyperplasia, unilateral cortical adenoma, Conn’s adenoma and bilateral hyperplasia.…”

“…In the presented case, the relatively young age of the patient could suggest that the aldosterone hypersecretion possibly contributed to the vascular damage. There are only a few reported cases [5,6,7,8] of aortic dissection in patients with primary hyperaldosteronism, and we can only speculate about the casual relationship between these two clinical diagnoses.…”

Molecular Mechanism of the Inhibitory Effect of Aldosterone on Endothelial NO Synthase Activity

“…However, numerous studies have shown unexpectedly that PA is associated with an increased prevalence of cardiovascular complications, such as aortic dissection, myocardial infarction, or stroke. [1][2][3] In addition, recent clinical trials, the Randomized ALdactone Evaluation Study (RALES) and Eplerenone Post-acute myocardial infarction Heart failure Efficacy and SUrvival Study (EPHESUS), showed that mineralocorticoid receptor (MR) antagonists improved the prognosis of chronic heart failure patients even at doses below the threshold that caused significant renal effects. 4,5 This finding suggested that MR antagonism may have a direct protective effect on the cardiovascular system.…”