Adrenal vein sampling and adrenal nodular hyperplasia (Conn syndrome)

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient has had hypertension for years. Renin was found to be low. A CT was requested to look for a phaeochromocytoma.

Patient Data

Age: 56
Gender: Male
CT

CT adrenal glands (non contrast)

Nodular hyperplasia of the left adrenal gland (density 5-15 HU). The right adrenal gland appears normal. Given the clinical history, this may represent an adrenal cortical adenoma causing Conn's syndrome. This may be further investigated with adrenal vein sampling and endocrinology aldosterone testing.

DSA (angiography)

Adrenal vein sampling

Specimens were sent for analysis of aldosterone and cortisone as requested.

 

Diagram

Result of adrenal vein sampling.

The sample from the left adrenal gland is clearly abnormal and in keeping with primary hyperaldosteronism.

Case Discussion

Primary hyperaldosteronism can be due to adrenal hyperplasia (60%), adrenal adenoma (40%), glucocorticoid-remediable hyperaldosteronism (dexamethasone-suppressible hyperaldosteronism), <1%, and rare entities, such as disorders of the renin-angiotensin system (<1%)

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Case information

rID: 30561
Case created: 19th Aug 2014
Last edited: 22nd Sep 2015
Inclusion in quiz mode: Included

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