Primary aldosteronism in a patient with an aldosterone-producing adenoma

We describe an unusual patient presenting with a history of refractory hypertension and hypokalemia. Initial screening tests for adrenal hypertension were consistent with primary aldosteronism and an abdominal computed tomography scan showed an 8-mm left adrenal mass. However, adrenal venous sampling revealed markedly suppressed plasma aldosterone in the left adrenal vein but increased plasma aldosterone in the right adrenal vein. Therefore, on the basis of the clinical, radiographic, and laboratory findings, we concluded that the patient had a nonfunctioning adrenocortical adenoma on the left and an aldosterone-producing adrenocortical adenoma on the right, with the aldosteronoma resulting in hypertension and hypokalemia. Right adrenalectomy decreased the hypertension and corrected the hypokalemia. The right adrenal contained a 7-mm nodule microscopically consistent with the diagnosis of a cortical adenoma. The case highlights key steps and potential pitfalls in the evaluation of adrenal hypertension.