SIMULTANEOUS SCINTIGRAPHIC DEPICTION OF ALDOSTERONOMA AND ADRENAL INFARCTION

Primary aldosteronism is a potentially curable cause of hypertension, especially when caused by an adrenal adenoma. Aldosteronomas because o f their small size often elude techniques to locate them. This case il lustrates the advantages, disadvantages and complications of noninvasi ve and invasive techniques used for their diagnosis. A patient with hy pertension and hypokalemia underwent an adrenal venous effluent sampli ng for measurement of aldosterone concentrations. This procedure was c omplicated by an injury to the right adrenal gland. Subsequently, it w as difficult to control the patient's hypertension and hypokalemia wit h medical therapy alone. A re-assessment years after his initial diagn osis included a CT scan, which now visualized a left adrenal tumor. Th e functional status of this tumor and lack of function of the previous ly injured right adrenal gland were demonstrated by NP-59 scintigraphy . This information modified the surgical intervention (adenectomy rath er than total adrenalectomy) and the residual left sided adrenal tissu e prevented adrenocortical insufficiency. A year later the patient rem ains euadrenal.