Diagnosis of primary aldosteronism in a patient with an incidentally found adrenal mass.
BACKGROUND
A 50-year-old woman who was complaining of abdominal pain was referred to the endocrine clinic after a small (0.8 cm by 0.8 cm) mass was found in her right adrenal gland on CT examination of the abdomen. She had a history of hypertension for 10 years, generalized anxiety disorder for 5 years and a weight increase of 18 kg over the previous 3 years. The patient did not report weakness, polyuria or excessive thirst. She had a history of hypokalemia while on hydrochlorothiazide therapy. To improve blood pressure control, a total of three antihypertensive medications had been sequentially added to her regimen. At presentation, medications included 300 mg irbesartan daily, 5 mg amlodipine daily and 100 mg sustained-release metoprolol daily.


METHODS
Renin activity, levels of plasma aldosterone and levels of fractionated plasma metanephrines were measured and an overnight 1 mg dexamethasone suppression test was performed. In addition, measurements of urine aldosterone excretion on a high-salt diet, MRI-examination of the adrenal glands and bilateral adrenal vein sampling were conducted.


METHODS
An aldosterone-secreting adrenal adenoma.


RESULTS
The patient underwent laparoscopic resection of the right adrenal gland, which led to normalization of aldosterone excretion, lowering of her blood pressure on a single antihypertensive medication (50 mg sustained-release metoprolol daily) and resolution of hypokalemia.
Tritos
Nicholas A
NA
Lahey Clinic Medical Center, Department of Endocrinology, Burlington, MA 01805, USA. nicholas.a.tritos@lahey.org
D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000311:Adrenal Glands / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged
D000450:Aldosterone