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 pheochromocytoma.

Patient Data

Age: 55 years
Gender: Male

CT adrenal glands (non contrast)

ct

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.

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

 

Result of adrenal vein sampling.

Diagram

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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