Secondary Hypertension in a 45-Year-Old Female Caused Dizziness and Fatigue, Significant Improvement After Surgery

In this case study, we explore the journey of a 45-year-old female patient who suffered from chronic dizziness and fatigue for over a decade. Her condition was eventually diagnosed as secondary hypertension caused by primary aldosteronism. Following a successful surgical intervention, her symptoms improved significantly. This article is intended for educational and informational purposes only, and all patient details have been altered to protect privacy.

Patient Overview

The patient was a 45-year-old woman who had been experiencing persistent symptoms of dizziness and fatigue since 2009. Her blood pressure was found to be elevated, reaching a peak of 165/120 mmHg. Despite regular use of antihypertensive medications such as amlodipine besylate and irbesartan, her blood pressure remained poorly controlled.

Diagnosis and Testing

Initial outpatient tests revealed elevated aldosterone levels and a high aldosterone-to-renin ratio (ARR), suggesting the possibility of primary aldosteronism (PA). Although adrenal ultrasound did not show any abnormalities, further diagnostic testing was necessary. A saline suppression test confirmed the diagnosis, showing aldosterone levels remaining above 100 pg/ml post-test. An adrenal contrast CT scan revealed thickening of the left adrenal gland, indicating adrenal hyperplasia.

Adrenal Vein Sampling (AVS)

To confirm the diagnosis and determine the exact location of the issue, adrenal vein sampling was performed. The results showed a clear left-sided dominance in aldosterone secretion, solidifying the diagnosis of secondary hypertension due to primary aldosteronism.

Treatment Plan

Given the patient's willingness to pursue surgical treatment, a laparoscopic left adrenalectomy was scheduled. The procedure was performed on October 7 under general anesthesia and was completed successfully without complications.

Post-Operative Recovery

Following the surgery, the patient's blood pressure and aldosterone levels began to decline. She was discharged one week post-operation. Follow-up tests in November 2019 showed aldosterone at 228.2 pg/ml, renin activity at 4.979 ng/ml/h, and potassium at 3.95 mmol/L. By March 2021, her aldosterone levels had further decreased to 145 pg/ml, and renin activity had improved significantly, indicating recovery from prior suppression. Her potassium levels also showed a slight increase.

The patient continued to take amlodipine besylate but discontinued irbesartan. Her blood pressure remained well-controlled, and she reported a noticeable improvement in energy levels and overall well-being.

Post-Treatment Recommendations

To maintain long-term health benefits, the patient was advised to adopt a healthy lifestyle including a balanced diet, regular exercise, and stress management. Blood pressure monitoring was strongly recommended, with weekly checks and additional monitoring during seasonal changes. If blood pressure remained below 120/70 mmHg for a sustained period, discontinuation of medication under medical supervision was considered. In case of elevated home readings above 135/85 mmHg or persistent symptoms, prompt medical follow-up was advised.

Clinical Insights and Reflections

This case highlights the importance of early diagnosis and targeted treatment in patients with secondary hypertension. Globally, many individuals with primary aldosteronism are misdiagnosed and treated as having essential hypertension. While their blood pressure may be controlled, the harmful effects of excess aldosterone on the cardiovascular and renal systems remain unaddressed, increasing the risk of complications such as myocardial hypertrophy, arrhythmias, and chronic kidney disease.

In regions with adequate medical resources, it is crucial to screen patients with newly diagnosed hypertension, especially those with hypokalemia, resistant hypertension, or adrenal abnormalities. Accurate diagnosis through tests like the saline suppression test and adrenal vein sampling can guide optimal treatment strategies and significantly improve patient outcomes.