A patient with concurrent primary aldosteronism and Page kidney.
The ratio of aldosterone-to-renin activity is currently recommended as a screening test for primary aldosteronism (PA). There are many factors interfering the interpretation of aldosterone-renin ratio (ARR) and could hamper in-time diagnosis of PA. Here, we first report a patient with underlying Page phenomenon and an accidentally disclosed adrenal incidentaloma. High renin secretion from Page phenomenon had masked higher ARR into normal ARR obscuring the diagnosis of PA. However, adrenal venous sampling (AVS) confirmed the autonomous aldosterone secretion with left adrenal vein plasma aldosterone concentration (PAC) 124.1 ng/dl and a lateralization ratio 3.3. AVS may discriminate masked PA due to high renin secretion from Page kidney. It is suggested that clinicians should cautiously interpret aldosterone-renin ratio and consider diagnostic AVS if hyperaldosteronism is highly suspected especially in the background of other secondary hypertension.
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. chinchik@gmail.com
Chin-Chi
CC
Kuo
Huan-Lun
HL
Hsu
Chao-Yuan
CY
Huang
Kao-Lang
KL
Liu
Vin-Cent
VC
Wu
Ching-Wei
CW
Tsai
Wei-Jie
WJ
Wang
D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D000311:Adrenal Glands / Q000098:blood supply / Q000378:metabolism; D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications*; D006977:Hypertension, Renal / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D033162:Incidental Findings; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D012083:Renin / Q000097:blood / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D014680:Veins
D000450:Aldosterone; D012083:Renin