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Diagnosis of primary aldosteronism in a patient with an incidentally found adrenal mass

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 547–551 (2007)Cite this article

Abstract

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.

Investigations 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.

Diagnosis An aldosterone-secreting adrenal adenoma.

Management 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.

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Figure 1: CT scan of the abdomen, obtained after administration of oral and intravenous contrast material
Figure 2: MRI scans of the abdomen in coronal (A) and axial (B, C) planes, respectively

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Authors and Affiliations

  1. NA Tritos is a senior staff Physician of the Department of Endocrinology at Lahey Clinic Medical Center, Burlington, MA, and Assistant Professor of Medicine at Tufts University School of Medicine, Boston, MA, USA.,

    Nicholas A Tritos

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  1. Nicholas A Tritos
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Correspondence to Nicholas A Tritos.

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Tritos, N. Diagnosis of primary aldosteronism in a patient with an incidentally found adrenal mass. Nat Rev Endocrinol 3, 547–551 (2007). https://doi.org/10.1038/ncpendmet0553

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