| Popis: |
Primary aldosteronism is an underdiagnosed cause of hypertension. Classically, primary hyperaldosteronism presents with hypertension and hypokalemia, although hypokalemia is not necessary to diagnose this condition. We present here a curious case of Aldosteronoma presenting without hypertension. 64-year-old lady with history of Crohn’s disease s/p colectomy and end-ileostomy in 1992 with chronic high output from ileostomy and non-anion gap metabolic acidosis with hypokalemia. Given CKD stage 4, she was being evaluated for renal transplant. She had a right adrenal incidentaloma noted on CT of the abdomen in 2013 measuring 3.2 x 2.5 cm. Repeat CT abdomen in 2015 showed the adenoma had very minimally enlarged in size and measured 3.6 x 2.7 cm. It was well circumscribed, low density with 27 HU. No adrenal washout was performed. She had no symptoms or signs suggesting pheochromocytoma or Cushing syndrome. She was noted to have chronic hypokalemia needing oral potassium supplementation three times a day. She has always been normotensive. She had normal levels of plasma metanephrines, a positive dexamethasone suppression test with cortisol being 3.7 mcg/dL but a normal midnight salivary cortisol level of 0.03 mcg/dL and a normal DHEAS level of 246 mcg/dL. Her 8 AM aldosterone level was 2860 ng/dL (upright |
