A Rare Case of Mitral Regurgitation Caused by Primary Aldosteronism

A 53-year-old woman with hypertension was admitted for palpitation, shortness of breath, and intermittent chest pain after activity. Physical examination revealed an apical systolic murmur. Laboratory tests suggested hypernatremia, hyperchloremia, and hypokalemia. Electrocardiogram showed frequent ventricular premature beats and ST-T changes (Panel A). Transthoracic and transesophageal echocardiography indicated the left atrial and ventricular enlargement, severe mitral regurgitation caused by mitral insufficiency (Panels B and C). Naturally, the patient was diagnosed with severe mitral regurgitation and was prepared for mitral valvuloplasty. During preoperative preparation, the patient was routinely treated with potassium supplements and antihypertensive and anti-heart failure drugs. Meanwhile, the assistant endocrinologist suggested further examinations to check for primary aldosteronism. Another laboratory test showed an aldosterone-renin ratio >100, and abdominal CT showed a 28 × 20 mm nodular lesion in the left adrenal gland (Panel D). Therefore, the patient’s primary aldosteronism was diagnosed. We considered that the patient’s mitral regurgitation was due to primary aldosteronism leading to resistant hypertension and deleterious myocardial remodeling. Therefore, the patient needed adrenal surgery rather than valve surgery. With 1 week of medication including spironolactone, hydrochlorothiazide, potassium chloride, sacubitril valsartan, nifedipine, and terazosin, repeat echocardiography showed mild-moderate mitral regurgitation with a normal mitral annulus size (Panels E and F, Video). Following, the patient underwent surgery for a hypernephroma by urologists and is well now at her 3-month follow-up visit. To our knowledge, this is the first reported case that primary aldosteronism is a rare cause of severe mitral regurgitation which may be treated successfully without valvular surgery.