“My blood pressure is high” continued

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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