Primary hyperaldosteronism presenting as recurrent polymorphic ventricular tachycardia (RCDD code: VI-2)

Marian Hrebenyk, Roman Komorovsky, Taras Bidovanets

Full Text:

PDF

Abstract


Primary hyperaldosteronism (PH) is a frequently overlooked cause of secondary hypertension mostly due to an aldosterone-producing adrenal adenoma. We report the case of a 48-year-old female who presented with recurrent episodes of polymorphic ventricular tachycardia before an aldosterone-producing adrenal adenoma was diagnosed. Although her past medical history was remarkable for poorly-controlled hypertension since age 30, she had never been examined for secondary causes. The patient underwent adrenalectomy
resulting in stabilisation of her clinical condition, although residual hypertension remained. Causes of atypical presentation and diagnostic pitfalls are discussed. JRCD 2018; 4 (1):


Keywords


primary hyperaldosteronism; polymorphic ventricular tachycardia; secondary hypertension; hypokalemia; rare atypical presentation

References


Katayama Y, Takata N, Tamura T, et al. A case of primary aldosteronism due to unilateral adrenal hyperplasia. Hypertens Res 2005;28:379–384.

Calhoun DA. Aldosteronism and hypertension. Clin J Am Soc Nephrol 2006;1:1039–1045.

Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 2017;69:1811–1820.

Buffolo A, Monticone S, Burrello J, et al. Is primary aldosteronism still largely unrecognized? Horm Metab Res 2017;49:908–914.

Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016;101:1889–1916.

Williams TA, Reincke M. Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited. Eur J Endocrinol 2018;179:R19-R29.

Gordon RD. The importance of not overlooking curable hypertension: primary aldosteronism rarely screened for reflecting poor uptake of Endocrine Society Guidelines. J Hypertens. 2016;34: 2143–2144.

Wolley MJ, Stowasser M. New advances in the diagnostic workup of primary aldosteronism. J Endocr Soc 2017;1:149–161.

Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004;89: 1045–1050.

Ghanem N, Altehoefer C, Thürl C, et al. Computertomographie und Magnetresonanztomographie in der Differenzialdiagnose von

Nebennierenraumforderungen. Med Klin 2004;99:447–452.

Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalecromy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 2017;5:689–699.

Williams B, Mancia G, Siering W, et al. for the ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021–3104.

Wang W, Hu WL, Zhang XM, et al. Predictors of successful outcome after adrenalectomy for primary aldosteronism. Int Surg 2012;97:104–111.

Rossi GP, Bolognesi M, Rizzoni D, et al. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 2008;51:1366–1371.

Shinde SD, Sabnis GR, Lanjewar CP, et al. A rare endocrine cause of electrical storm – a case report. Eur Heart J – Case Reports 2017;1:1–5.

Foglia PEG, Bettinelli A, Tosetto C, et al. Cardiac work up in primary renal hypokalemia-hypomagnesemia (Gitelman syndrome). Nephrol Dial Transplant 2004;19:1398–1402.

Khan IA. Clinical and therapeutic aspects of congenital and acquired long QT syndrome. Am J Med 2002;112:58–66.

Chang KY, Lee SH, Park SH, et al. Severe hypokalemia and thyrotoxic paralysis from painless thyroiditis complicated by lifthreatening polymorphic ventricular tachycardia and rhabdomyolysis. Intern Med 2014;53:1805–1808.

Hakami O, Ahmad MA, Al Johani N. A case of nonfatal ventricular arrhythmia due to thyrotoxic periodic paralysis in a Saudi patient as an initial presentation of Grave’s disease. Clin Med Insights Case Rep 2016;9:5–9.

Lee JI, Sohn TS, Son TS, et al. Thyrotoxic periodic paralysis presenting as polymorphic ventricular tachycardia induced by painless thyroiditis. Thyroid 2009;19:1433–1434.

Stunnenberg BC, Deinum J, Links TP, et al. Cardiac arrhythmias in hypokalemic periodic paralysis: hypokalemia as only cause? Muscle Nerve 2014;50:327–332.

Pachulski RT, Lopez F, Sharaf R. Gitelman’s not-so-benign syndrome. N Engl J Med 2005;353:850–851.

Vanga SR, Annapureddy C, Biria M, et al. Monomoprhic outflow tract ventricular tachycardia: unique presenting manifestation of Gitelman’s syndrome. J Atr Fibrillation 2010;2:229.

Rauf MA, Zef S, Adil M, et al. A 13-year-old girl with muscle weakness and ventricular tachycardia. Pak Heart J 2012;45:133–137.

Sakamoto M, Sato N, Goto M, et al. Three cases of corticosteroid therapy triggering ventricular fibrillation in J-wave syndromes. Heart Veseels 2014;29:867–872.

Araki T, Konno T, Itoh H, et al. Brugada syndrome with ventricular tachycardia and fibrillation related to hypokalemia. Circ J 2003;67:93–95.

Panduranga P, Al Rawahi N. Licorice-induced severe hypokalemia with recur- rent torsade de pointes. Ann Noninvasive Electrocardiol 2013;18:593–596.

Saliba W, Erdogan O, Niebauer M. Polymorphic ventricular tachycardia in a woman taking cesium chloride. Pacing Clin Electrophysiol 2001;24:515–517.

Mirzoyev SA, McLeod C, Bunch J. Hypokalemia during the cooling phase of therapeutic hypothermia and its impact on arrhythmogenesis. Resuscitation 2010;81:1632–1636.

Podolec P, Kopeć G, Rubiś P, et al. Clinical classification of rare cardiovascular diseases and disorders: 2018 update. J Rare Cardiovasc Dis 2018;3:230–235.




DOI: http://dx.doi.org/10.20418%2Fjrcd.vol4no1.341

Refbacks

  • »
  • »
  • »
  • »
Journal of Rare Cardiovascular Diseases (JRCD)
John Paul II Hospital in Kraków, 80 Prądnicka Str., 31-202 Kraków, Poland
Phone: +48 (12) 614 33 99, +48 (12) 614 34 88 Fax: +48 (12) 614 34 88
e-mail: rarediseases@szpitaljp2.krakow.pl
Published by SoftQ sp. z o.o.
ul. Oleandry 2, 30-063 Kraków, Poland
Phone: +48 (12) 444 1650 Fax: +48 (12) 444 1659
e-mail: softq@softq.pl