Misdiagnosis of two cases of primary aldosteronism owing to failure of computed tomography to detect adrenal microadenoma.
Recent studies have suggested that primary aldosteronism (PA) is a common form of hypertension. However, some cases of PA are overlooked because microadenoma is difficult to detect by imaging. The author report 2 cases in which aldosterone-producing microadenoma was diagnosed by selective adrenal venous sampling (AVS) and furosemide plus upright test. These adenomas were resected by laparoscopic adrenalectomy. Both cases presented with hypertension and hypokalemia. Experimental data, including those obtained from furosemide plus upright test, suggested PA. In both cases, computed tomography imaging revealed a normal adrenal gland without any tumor. However, selective AVS indicated unilateral hypersecretion of aldosterone. Laparoscopic adrenalectomy was performed, and clinical symptoms of the patients improved. The histopathologic findings revealed aldosterone-producing microadenomas with diameters of 6 and 3 mm, respectively, in cases 1 and 2. In conclusion, AVS should be performed to confirm the diagnosis of PA when computed tomography imaging does not provide definite results.
Fujiwara
Mako
M
Department of Internal Medicine, Kagawa University, Kagawa, Japan.
Murao
Koji
K
Imachi
Hitomi
H
Yoshida
Kazuya
K
Muraoka
Tomie
T
Ohyama
Tomoyo
T
Kushida
Yoshio
Y
Haba
Reiji
R
Kakehi
Yoshiyuki
Y
Ishida
Toshihiko
T
D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000311:Adrenal Glands / Q000098:blood supply; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006973:Hypertension / Q000209:etiology; D007008:Hypokalemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D000450:Aldosterone