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Case Reports
. 2024 Jun 11;16(6):e62123.
doi: 10.7759/cureus.62123. eCollection 2024 Jun.

Adrenal Mass and Hypokalaemia: The Zebra Among Horses

Zsuzsanna Reti  1 , Laszlo Szabo  1 , Radu M Neagoe  2 , Melinda Kolcsar  3
Affiliations
Case Reports

Adrenal Mass and Hypokalaemia: The Zebra Among Horses

Zsuzsanna Reti et al. Cureus. .

Abstract

Pheochromocytoma rarely presents with unexplained hypokalaemia, although there are some case reports in the literature. The mechanism behind this could be the increased cellular potassium uptake promoted by beta-2-adrenoreceptor hyperactivation and insulin resistance. We present the case of a 68-year-old hypertensive female patient with a unilateral adrenal mass discovered on angio-CT and typical signs of adrenergic hyperstimulation (hypertensive crisis, headache, and sweating) associated with multiple arrhythmic episodes but with normal plasma and urinary catecholamine levels. During the work-up for hormonal hypersecretion and the cessation of anti-aldosterone medication, the patient presented resistant hypokalaemia. Due to uncorrectable hypokalaemia, we were unable to perform hormonal investigations for primary hyperaldosteronism and referred the patient for laparoscopic adrenalectomy. The histological diagnosis revealed left pheochromocytoma. Postoperatively, the patient experienced rebound hyperkalaemia. In a patient with a unilateral adrenal mass and hypokalaemia, besides primary hyperaldosteronism and adrenocorticotropic hormone-independent hypercortisolism, a possible pheochromocytoma should be ruled out as well by the clinician before surgery.

Keywords: adrenal mass; electrolyte imbalance; hypertension; hypokalaemia; pheochromocytoma.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT scans of the left adrenal mass
Arrows showing the adrenal tumour dimensions in consecutive evaluations, year 2010 (Panel A) and year 2011 (Panel B)
Figure 2
Figure 2. Microscopy of the excised tumour
Panel A, microscopy: HE, scale bar 400μm, 5x magnification: tumoural proliferation made of small nests of neuroendocrine cells, poorly delimited from the cortical region. Panel B, microscopy: HE, 100μm, 20x high magnification: Zellballen pattern, with prominent uniform cell nests consisting of polygonal tumour cells with mild pleomorphism. (HE: hematoxylin-eosin staining) (Courtesy of Prof. Dr. Borda A - Pathology Department, Emergency County Hospital/George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures)
See this image and copyright information in PMC

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