Primary hyperaldosteronism: a case of unilateral adrenal hyperplasia with contralateral incidentaloma

Abstract

Primary hyperaldosteronism is one of the most common causes of secondary hypertension but clear differentiation between its various subtypes can be a clinical challenge. We report the case of a 37-year-old African-American woman with refractory hypertension who was admitted to our hospital for palpitations, shortness of breath and headache. Her laboratory results showed hypokalaemia and an elevated aldosterone/renin ratio. An abdominal CT scan showed a nodule in the left adrenal gland but adrenal venous sampling showed elevated aldosterone/renin ratio from the right adrenal vein. The patient began a new medical regimen but declined any surgical options. We recommend clinicians to maintain a high level of suspicion to consider the less common subtypes of primary hyperaldosteronism, especially given the fact that the management greatly varies.

Figure 1

Transverse CT scan of the abdomen and pelvis showing an enhanced nodule measuring 1.1×1.2 cm in the lateral limb of left adrenal gland.

Figure 2

Transverse MRI of the abdomen showing single dropout compatible with the left adrenal adenoma measuring 11 mm.

Figure 3

Coronal MRI of the abdomen showing single dropout compatible with the left adrenal adenoma measuring 11 mm.