Pitfalls in the diagnosis and management of primary hyperaldosteronism

Primary hyperaldosteronism remains a diagnostic challenge. In clinical practice, both the initial diagnosis as well as differentiation of the subtypes of hyperaldosteronism may not always be straightforward. If done successfully and interpreted carefully adrenal venous sampling is extremely accurate in distinguishing the subtypes of hyperaldosteronism. We present herein the case of a 49-year-old man who presented with long-standing hypertension and recurrent hypokalemia. The laboratory work-up was consistent with primary hyperaldosteronism. An abdominal computed tomography scan revealed an 8 mm left adrenal adenoma with questionable thickening of the right adrenal limb. An iodocholesterol (NP-59) scan failed to localize an adrenal lesion. Subsequently, bilateral adrenal venous sampling was performed, confirming a diagnosis of left aldosteronoma, and the patient underwent a successful left adrenalectomy.