Layden Brian T, Hahr Allison J, Elaraj Dina M
Division of Endocrinology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BMC Res Notes. 2012 Oct 30;5:602. doi: 10.1186/1756-0500-5-602.
Primary hyperaldosteronism (PA) is a serious and potentially debilitating disease. Detailed guidelines have been written to guide endocrinologists in establishing the diagnosis of PA as well as in subtype classification of PA. The objective of this case report is to present a case where subtype classification of PA was challenging and repeated imaging of the adrenal glands helped establish the diagnosis in a patient with initial normal adrenal glands on CT and MRI images.
We report a case of a 29-year-old woman with an established diagnosis of PA, but unclear subtype, who presented to us for further management. She initially presented for medical evaluation of uncontrolled hypertension and spontaneous hypokalemia 4 years prior. In the investigation of secondary causes of hypertension, plasma aldosterone-to-plasma renin activity ratio was elevated on two separate occasions, and primary hyperaldosteronism was confirmed by saline infusion test. Also during this time, she had adrenal venous sampling done 3 times at multiple institutions yielding confusing results. Initially, imaging by CT and MRI showed normal adrenal glands. To help establish the subtype of PA, we reimaged this patient's adrenal glands one year later revealing a 2 cm left adrenal adenoma. Laparoscopic left adrenalectomy improved her hypertension and was curative of her hypokalemia.
This case presents an unusual case where reimaging of the adrenal glands led to the discovery of a single adenoma, initially not observed on imaging studies.
原发性醛固酮增多症（PA）是一种严重且可能使人衰弱的疾病。已经制定了详细的指南，以指导内分泌科医生进行PA的诊断以及PA的亚型分类。本病例报告的目的是介绍一例PA亚型分类具有挑战性的病例，肾上腺的重复成像有助于对一名CT和MRI图像上肾上腺最初正常的患者进行诊断。
我们报告一例29岁已确诊PA但亚型不明的女性患者，她前来我们这里寻求进一步治疗。她最初是在4年前因无法控制的高血压和自发性低钾血症前来进行医学评估的。在对高血压的继发原因进行调查时，血浆醛固酮与血浆肾素活性比值在两个不同时间点升高，盐水输注试验证实了原发性醛固酮增多症。在此期间，她还在多家机构进行了3次肾上腺静脉采样，结果令人困惑。最初，CT和MRI成像显示肾上腺正常。为了帮助确定PA的亚型，我们在一年后对该患者的肾上腺进行了再次成像，发现左侧肾上腺有一个2厘米的腺瘤。腹腔镜下左侧肾上腺切除术改善了她的高血压，并治愈了她的低钾血症。
本病例呈现了一种不寻常的情况，即肾上腺的再次成像导致发现了一个最初在影像学检查中未观察到的单一腺瘤。
