Presentation
Hypertension with biochemically confirmed hyperaldosteronism.
Patient Data
Adrenal glands: maintain adreniform shape:
Right: width measurements of the body: 14mm (including the nodule), and limbs: average 4.5-5mm, a (13.8x12.3) mm nodule expanding the medial aspect of the body at its junction with the medial limb was seen with a pre-contrast mean density: 3 HU, 65 seconds post-contrast mean density:22 HU and 15-minute delayed density: 2 HU resulting in an absolute washout:105.3% and relative washout:90.9% consistent with an adrenal adenoma.
Left: width measurements of the body: 6.5mm, and limbs: average 4-4.5mm, no apparent nodule
At least three non-calcified masses consist predominantly of macroscopic fat and show minimal enhancement post-contrast measure: 8x7,9x6mm in the upper and lower pole of the right kidney and 7x5mm in the left lower pole, no hemorrhage… features strongly indicative of multiple angiomyolipomas and given their size, active surveillance is usually unnecessary
Case Discussion
While in the provided clinical context this likely represents an aldosterone-producing adenoma, however keeping in mind the patient’s age, Adrenal vein sampling(AVS)-/+scintigraphy has been advocated to ascertain/lateralize the function and exclude contralateral hyperfunctioning micronodule before surgical intervention.
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