Reversibility of myocardial hypertrophy 8 years after adrenal adenoma excision and drugs and alcohol addiction withdrawal.

To cite: Carboni GP. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013009738 DESCRIPTION In November 2005, a 37-year-old patient presented to us with a systolic blood pressure (BP) >180 Hg and a diastolic BP >110 Hg and a history of dramatic hypertensive crises despite adherence to treatment with several antihypertensive drugs. He worked as a waiter in a nightclub where he was exposed to tiredness and fatigue while working nights. He sniffed at least 2 g of cocaine, smoked around 2 g of hashish and drank more than 500 ml of brandy nearly every night. This habit lasted for 5 years. Despite the presence of a positive direct relationship between cocaine, hashish, alcohol abuse and hypertension, 2 the patient underwent a clinical workup to rule out other causes of secondary hypertension. The findings of hypokalaemia and increased values of aldosteronaemia and aldosteronuria suggested a diagnosis of primary aldosteronism. Echocardiography found a severe left ventricular hypertrophy (LVH). Abdominal CT identified a mass on the left adrenal gland (figure 1). The gland was excised by laparoscopic surgery (figure 2), and histological examination of the mass indicated adrenal adenoma. After surgery, the patient began a new job as a clerk with a normal working day and gradually discontinued drug and alcohol abuse. A daily treatment with 240 mg of verapamil and 50 mg of losartan maintained normal BP values. After an 8-year follow-up, echocardiography showed a reduction of the LV mass and LVH (figure 3). These results indicate a favourable prognosis for cardiovascular events in this patient.