Pitfalls in the diagnosis and treatment of a hypertensive patient with unilateral primary aldosteronism and contralateral pheochromocytoma: a case report

BMC Endocrine Disorders

Case Report

Haruto Nishida¹  Tsutomu Daa¹  Yuichi Yoshida²  Hirotaka Shibata²  Yoshinori Ozeki²  Koro Gotoh²  Takayuki Masaki²  Shotaro Miyamoto²  Mitsuhiro Okamoto²  Yoshiki Asayama³  Hiroyuki Fujinami⁴  Toshitaka Shin⁴ 

[1] Department of Diagnostic Pathology, Faculty of Medicine, Oita University, 879-5593, Yufu City, Oita, Japan;Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 879-5593, Yufu City, Oita, Japan;Department of Radiology, Faculty of Medicine, Oita University, 879-5593, Yufu City, Oita, Japan;Department of Urology, Faculty of Medicine, Oita University, 879-5593, Yufu City, Oita, Japan;

关键词: Primary aldosteronism;    Pheochromocytoma;    Secondary hypertension;    Adrenal masses;    Concomitant primary aldosteronism;    Pheochromocytoma;   

DOI  :  10.1186/s12902-023-01297-3

 received in 2022-07-05, accepted in 2023-02-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPrimary aldosteronism (PA) is a common cause of secondary hypertension, whereas pheochromocytoma is a rare cause of it. Thus, concomitant PA and pheochromocytoma is a very rare condition.Case presentationA 52-year-old woman was admitted to our hospital with suspected PA based on the presence of hypertension, spontaneous hypokalemia, and a high aldosterone-to-renin ratio. She had no catecholamine excess symptoms other than hypertension. Abdominal computed tomography (CT) showed a right lipid-rich adrenal mass and a left lipid-poor adrenal mass. PA was diagnosed by the captopril challenge test. The 24-h urinary fractionated metanephrines were slightly elevated. Adrenal vein sampling (AVS) confirmed that the right adrenal gland was responsible for aldosterone hypersecretion. Medical therapy with eplerenone was started because the patient refused surgery. Five years later, she requested surgery for PA. The second AVS confirmed right unilateral hyperaldosteronism, as expected. Repeated abdominal CT showed the enlargement of the left adrenal mass. The 24-h urinary fractionated metanephrines had risen to the diagnostic level. 123I- metaiodobenzylguanidine (MIBG) scintigraphy showed a marked tracer uptake in the left adrenal mass with no metastatic lesion. After preoperative management with α-blockade, laparoscopic left partial adrenalectomy was performed. Immunohistochemical examination of the tumor showed chromogranin A positivity leading to the diagnosis of left pheochromocytoma.ConclusionsWe report an extremely rare case of concomitant unilateral PA and contralateral pheochromocytoma. When diagnosing unilateral PA by AVS, especially in cases with a lipid-poor adrenal mass, clinicians should rule out the possibility of the presence of pheochromocytoma before proceeding to undergo unilateral adrenalectomy. Although there is no standard treatment for this rare condition, it is essential to select personalized treatment from the perspective of conserving the adrenal gland.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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