Endocrine Abstracts

Primary hyperaldosteronism represents a current and underdiagnosed cause of secondary hypertension, characterized by inordinate and independent aldosterone production. While adrenal venous sampling (AVS) has surfaced as the gold standard for lateralization of aldosterone excess, its operation in cases of grueling primary hyperaldosteronism remains less explored. In this unique case history, we present the clinical script of a case with suspected primary hyperaldosteronism, flaunting atypical biochemical and imaging findings. This case of a 45- year old male who presented to the clinic with complaints of high blood pressure, rhythm disturbances, palpitaions, dyspnea and muscle cramps. While all the symptoms were experiences unexpectedly, he had no memory of these symptoms in the past. He was being managed in an outpatient department for hypokalemia and hypertension since the age of 38. He has been taking three antihypertensives (amlodipine, enalapril, labetalol) and supplemental potassium (2 tablets of 10 mEq three times a day). Initial investigations revealed normal hematological and renal parametres but sodium showed 135 mmol/l and potassium 2.5 mmol/l. ECG performed at the time of admission were unremarkable as well. Serum Aldosterone and renin levels were 97 ng/dl and 0.19 ng/ml/hour, respectively, and cortisol levels were 11.7 g/dl. The Aldosterone-Renin ratio was calculated to be 510 ng/dl per ng/(mg/hour). These markers were obvious in stating that there are some discrepancies in some of these levels of some parametres listes above. The abdominal contrast-enhanced Computed Tomography scan showed nodular lesions in the adrenal glands ; 7mm on the right and 37mm on the left which were probably adenoids with low lipid substrate (32 HU- hounsfield unit densities). A selective Adrenal Venous Sampling with Adrenocorticotropic Hormone Stimulation tests were performed. While the aldosterone and cortisol levels in the left adrenal vein were 97 ng/dl and >120 μg/dl, the levels in the right adrenal vein were 4086 ng/dl and >120 μg/dl, suggesting a diagnosis for Unilateral Adrenal Hyperplasia. Sarcastically, in this case, size didn’t matter but infact the hyperactivity did the work. A right adrenelectomy was done to the patient and medications such as spironolactone and oral potassium chloride were given orally during his hospital stay. His electrolytes and blood pressure were corrected 5th day after the surgery and he was subsequently discharged with verapamil, hydralizine, doxasozin and spironolactone. The aldosterone-renin ratio levels came 125 ng/dl(ml/hour)