| Autor: |
Ramadurgam Poliki Monica Reddy, Erika F. Brutsaert |
| Rok vydání: |
2019 |
| Předmět: |
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| Zdroj: |
Journal of the Endocrine Society |
| ISSN: |
2472-1972 |
| DOI: |
10.1210/js.2019-sun-372 |
| Popis: |
Background: AVS Adrenal vein sampling (AVS) is the gold standard for localizing the lesion in primary hyperaldosteronism. This case illustrates the limitations of AVS in cortisol co-secreting adenomas and highlights features of co-secreting adrenal adenomas. CASE: A 65 yr old man with hypertension and hypokalemia was diagnosed with primary hyperaldosteronism in the setting of low renin (0.41 ng/ml/h (0.25-5.82), elevated aldosterone level (39 ng/dl) and an elevated aldosterone-renin ratio (ARR) of 95. CT abdomen showed a 4.4 cm left adrenal mass with pre-contrast attenuation of negative 5 houndsfield units and 60 % post contrast washout. The patient also had elevated 24- hour urine free cortisol levels of 72.5 mcg/24hr (4.0-50.0) and an elevated morning cortisol of 10 ug/dl( 3.0 indicating appropriate catheter placement, however results failed to demonstrate a unilateral process (lateralization index ___ at 15 minutes). AVS was repeated off of spironolactone and the lateralization index was ___ at 15 minutes post ACTH. the pt underwent left adrenalectomy for growth of the adenoma and mild hypercortisolism. Pathology confirmed an adrenocortical adenoma. Despite 2 AVS that suggested a bilateral process, post-operatively potassium and blood pressure normalized and aldosterone level reduced to |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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