Diagnostic Challenges of Adrenal Venous Sampling for Primary Hyperaldosteronism in a Patient With Subclinical...

Area of Science:

• Endocrinology
• Nephrology
• Internal Medicine

Background:

• Hypertension is a prevalent comorbidity, with secondary hypertension accounting for 5%-10% of cases.
• Adrenal gland diseases are common causes of secondary hypertension, necessitating accurate diagnosis and management.
• This case presents a complex scenario involving uncontrolled hypertension, primary hyperaldosteronism, and mild autonomous hypercortisolism.

Purpose of the Study:

• To investigate the diagnostic challenges in a patient with uncontrolled hypertension and suspected adrenal gland pathology.
• To evaluate the utility of imaging and biochemical tests in differentiating adrenal adenoma from adrenal hyperplasia.
• To highlight the importance of comprehensive hormonal evaluation in hypertensive patients with adrenal incidentalomas.

Main Methods:

• Biochemical assays including electrolytes, renin, aldosterone, cortisol, and ACTH levels were performed.
• Abdominal computed tomography (CT) was used to identify adrenal masses.
• Adrenal vein sampling and the 1mg overnight dexamethasone suppression test were conducted for further diagnostic clarification.

Main Results:

• Laboratory findings were consistent with primary hyperaldosteronism (PHA).
• CT revealed an adrenal mass, but adrenal vein sampling suggested adrenal hyperplasia.
• The dexamethasone suppression test indicated mild autonomous hypercortisolism.

Conclusions:

• Computed tomography (CT) has limitations in differentiating adrenal adenomas from bilateral idiopathic adrenal hyperplasia.
• Patients aged 35 and older with adrenal incidentalomas require thorough evaluation for PHA, even with visible masses on CT.
• Comprehensive hormonal assessment is crucial for accurate diagnosis and management of secondary hypertension due to adrenal disorders.