Case Discussion BIA MAH-1398-10-09

Recommended screening tests in adrenal incidentalomas. Additional analyses in bilateral incidentalomas listed below will depend on the clinical presentation and family history.

Conn’s syndrome (adrenal aldosterone-producing adenoma) and bilateral adrenal hyperplasia are the most common causes of primary aldosteronism. The treatment of choice for patients with aldosterone-producing adenoma is unilateral total adrenalectomy. Recurrence after adequate surgery is exceptional.

A 62-year-old woman was admitted to the hospital because of severe hypokalemia and poorly controlled hypertension. She underwent adenomectomy for primary aldosteronism due to right APA 9 years ago. The pathological examination revealed a 2-cm diameter ad-enoma without other abnormalities. After surgery, she had been asymptomatic with normotension and normokalemia without pharmacologic treatment

In the follow-up repeated plasma renin activity and serum aldosterone levels were normal. Six months before admission, hypertension resistant to antihypertensive poly therapy, weakness and paraesthesias developed. At entry, her medications comprised fosinopril (20 mg daily),amlodipine (10 mg daily) and hydrochloro-iazide (25 mg daily). There was no family history of hypertension.