Q037

 

A Case of Primary Hyperaldosteronism with Discordant Imaging and Adrenal Vein Sampling Results

V Salem¹, H El-Gayar¹, J Jackson², F Palazzo³, T Tan¹ and K Meeran¹.

 

1. Department of Endocrinology  2. Department of Radiology 3. Department of Endocrine Surgery, all Imperial College Healthcare NHS Trust, Hammersmith Hospital

 

 

ABSTRACT

 

We present a case of a male patient diagnosed with hypertension by his GP in 2001 at the age of 53.  In 2005 he was noted to be hypokalaemic on bendrofluazide.  In 2007, he was referred to the Hammersmith Hospital to investigate hypertension (poorly controlled on three antihypertensives) associated with hypokalaemia.  Repeat aldosterone: renin ratio (ARR) measurements were suggestive of Conn’s (ARR on doxasozin alone >2950).  This was supported by postural renin and aldosterone measurements.  CT adrenals revealed a bulky left gland but normal right gland.  However, adrenal vein sampling (AVS) produced a discordant finding, with evidence of hypersecretion from the right and suppression of the left adrenal (A/C_right/A/C_left = 7.79  A/C_left/A/C_IVC = 0.83).  Repeat fine-cut adrenal CT showed no change, with a bulky left adrenal and normal right gland.  Based on the AVS findings, the patient underwent a laparoscopic right adrenalectomy.  Post-operatively, he has better blood pressure control on 2 antihypertensives and no longer requires potassium supplementation to maintain a normal serum level.  This case illustrates the central diagnostic importance of AVS in discriminating between unilateral versus bilateral disease in patients with primary aldosteronism, and in guiding the removal of the appropriate gland.