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U-002 DISSECTED AORTIC ANEURYSM: UNCOMMON INITIAL PRESENTATION OF PRIMARY ALDOSTERONISM

Background Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Recent studies have demonstrated that hyperaldosteronism might have vasculo-toxic actions associated with arterial structure, including remodeling, fibrosis, proliferation and modifying collagen and elastin contents. Dissected aortic aneurysm (DAA) is a lethal and serious complication of hypertension which is associated with vascular remodeling. However, the relation between PA and DAA is unclear. Method From 1993 Jan to 2011 May, 810 patients enrolled in the Taiwan Primary Aldosteronism Investigation (TAIPAI) database were studied. Four cases with DAA were selected and the clinical data were reviewed. Result Two cases referred to our hospital with presenting of acute chest pain. Computed tomography (CT) scanning showed ascending aortic dissection. Both of them received ascending aortic grafting but hypertension and hypokelemia were found after operation. They were diagnosed with PA on the basis of elevated plasma aldosterone, suppressed plasma renin, and an adrenal tumor detected by abdominal CT scanning. Another two cases with a history of untreated hypertension presented with cerebrovascular accident. Poor controlled hypertension, hypokelemia and decreased plasma renin were found during rehabilitation. CT revealed an adrenal tumor and DAA. Histological examination all revealed an adrenal adenoma in all four cases. Conclusion We reported the hypothesis of a possible relationship between PA and DAA. Physicians must be alert to the possibility of coexisting of these two diseases.