Resistant XXXX with adrenal nodule: are we removing the right gland?

@entity1 @entity1369 @entity101 @entity75 @entity700 @entity4383 @entity1368 @entity774
Resistant @entity101 is often difficult to treat and may be associated with underlying @entity1368 ( @entity1368 ). We describe the case of an elderly gentleman who presented with severe and resistant @entity101 and was found to have a left @entity700 during evaluation but had @entity1369 excess secondary to @entity774 ( @entity774 ) of the contralateral gland, which needed surgical intervention. A 65-year-old gentleman was evaluated for uncontrolled high blood pressure (BP) in spite of taking four antihypertensive medications. The high BP was confirmed on a 24-h ambulatory reading, and further biochemical evaluation showed an elevated serum @entity1369 renin ratio (ARR) (1577pmol/l per ng per ml per h). Radiological evaluation showed an adrenal nodule (15mm) in the left adrenal gland but an adrenal vein sampling demonstrated a lateralization towards the opposite site favouring the right adrenal to be the source of excess @entity1369 . A laparoscopic right adrenalectomy was performed and the histology of the gland confirmed @entity4383 . Following surgery, the @entity1 's BP improved remarkably although he remained on antihypertensives and under regular endocrine follow-up. @entity1368 remains the most common form of secondary and difficult-to-treat @entity101 . Investigations may reveal @entity75 , which may not be the actual source of excess @entity1369 , but @entity774 may be a contributor and may coexist and amenable to surgical treatment. An adrenal vein sampling should be undertaken for correct lateralization of the source, otherwise a correctable diagnosis may be missed and the incorrect adrenal gland may be removed. LEARNING POINTS: Severe and resistant @entity101 can often be associated with underlying @entity1368 .ARR is an excellent screening tool in @entity1 with suspected @entity1368 .Lateralization with adrenal venous sampling is essential to isolate the source and differentiate between unilateral and bilateral causes of @entity1368 . @entity700 and @entity774 may coexist and the latter may often be the sole cause of excess @entity1369 secretion.Decisions about adrenalectomy should be made only after integrating and interpreting radiological and biochemical test findings properly.
