ABSTRACT Hypertension is a significant comorbidity in the New World, and its prevalence is rising. Around 5%–10% of cases with hypertension have secondary hypertension. Adrenal gland disease is among the common causes of secondary hypertension. We present a 57‐year‐old male with uncontrolled hypertension and a history of intracranial hemorrhage. The lab evaluation of the patient revealed a K+ of 3.8 mEq/L, Na + of 138 mEq/L, Renin of 2.6 mIU/L, Aldosterone of 47.3 ng/dL, consistent with primary hyperaldosteronism (PHA). The patient's abdominal computed tomography (CT) revealed an adrenal mass measuring 21 mm in the right adrenal gland. However, the adrenal‐vein sampling showed that the mass is probably not the source of aldosterone excess, and a possible diagnosis of adrenal hyperplasia was made. To investigate the adrenal incidentaloma, the 1 mg overnight dexamethasone suppression test was performed. The 8 a.m. cortisol and ACTH levels were reported to be 5 microg/dL and 3.2 pg/mL, and a diagnosis of mild autonomous hypercortisolism was also made. CT is not an accurate method to differentiate between an adrenal‐producing adenoma and bilateral idiopathic adrenal hyperplasia. Even in cases where a visible mass is detected on CT, patients aged 35 or older need to be evaluated for the cause of PHA.
Sadra et al. (Sun,) studied this question.