Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning.
Primary aldosteronism is a disorder that is commonly considered in patients referred to the hypertension clinic. The ease of measuring the random aldosterone-to-renin ratio in conjunction with an elevated serum aldosterone level has led to an increased screening for this disorder. Typically, patients undergo a confirmatory test after a positive screening test. However, once primary aldosteronism is confirmed, subtype delineation is critical to decide on the optimal treatment. We report a patient with resistant hypertension and primary aldosteronism with a normal computed tomographic scan of the adrenal glands, a left-sided uptake on adrenal scintigraphy, and a right-sided lateralization of aldosterone after adrenal vein sampling. A repeat adrenal vein sampling confirmed the aldosterone lateralization to the right adrenal gland, which was then removed laparoscopically. The patient had a good clinical and biochemical response, and unilateral adrenal hyperplasia was discovered at histology. Excessive reliance on adrenal scintigraphy without adrenal vein sampling may lead to serious errors in patient management.
Mansoor
George A
GA
Section of Hypertension and Clinical Pharmacology, University of Connecticut Health Center, Farmington 06030-3940, USA. mansoor@nso1.uchc.edu
Malchoff
Carl D
CD
Arici
Melih H
MH
Karimeddini
Mozafareddin K
MK
Whalen
Giles F
GF
D000301:Adosterol; D000311:Adrenal Glands / Q000098:blood supply / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D006965:Hyperplasia; D006973:Hypertension / Q000150:complications; D007457:Iodine Radioisotopes; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D014018:Tissue Distribution; D014680:Veins
D007457:Iodine Radioisotopes; D000450:Aldosterone; D000301:Adosterol