This young male with difficult-to-control hypertension on maximum-dose therapy of two antihypertensives requires a workup for secondary hypertension.
Labs
- WBC 6,400, Hgb 13.6, Plt 245,000
- Na+ 146, K+ 2.8, Cl– 110, HCO3– 30, BUN 27, Creatinine 0.8, Calcium 8.5
- TSH: 2.4
- 8 AM Plasma Aldosterone Concentration (PAC): 22 ng/dL; Plasma Renin Activity (PRA): 0.6 ng/mL
- PAC:PRA Ratio: 37
- 8 AM Cortisol level: 18 mcg/dL
- Serum Normetanephrine: 60 pg/mL; Serum Metanephrine: 36 pg/mL
Imaging
- Renal Ultrasound with Doppler: No evidence of renal artery stenosis
- CT Abdomen/Pelvis with Adrenal Protocol: 4 cm mass in right adrenal gland suspicious for adrenal adenoma with a density of 8 Hounsfield units. Adrenal vein sampling found an elevated level of aldosterone in the right adrenal vein as compared to the left adrenal vein
Management
- Surgery was consulted and performed a right unilateral adrenalectomy. Patient recovered well post-operatively
- Pathology consistent with adrenal adenoma, no evidence of carcinoma found
- Blood pressure became better-controlled and patient was able to wean off of chlorthalidone entirely and down to lisinopril 10 mg daily
For more, see Secondary Hypertension
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