Functioning or Non-Functioning Adrenal Adenoma? Probably, Just a Matter of Time

Case Report

Austin Hypertens. 2016; 1(2): 1008.

Functioning or Non-Functioning Adrenal Adenoma? Probably, Just a Matter of Time

Colussi G¹*, Pezzutto F¹, Fagotto V¹, Rizzi C², Girometti R², Sechi LA¹ and Catena C¹

¹Department of Experimental and Clinical Sciences, University of Udine, Italy

²Department of Pathology, Academic Hospital of Udine, Italy

³Department of Medical and Biological Sciences, University of Udine, Italy

*Corresponding author: Colussi G, Department of Experimental and Clinical Sciences, University of Udine, Italy

Received: October 14, 2016; Accepted: November 27, 2016; Published: December 01, 2016


We present a 44-year-old female with an adrenal adenoma characterized by late autonomous secretion of aldosterone. The patient was admitted at our Hypertension Unit for a resistant form of severe hypertension with target organ damage and a history of adrenal non-functioning adenoma. Seven years before admission, the patient was evaluated for a mild normokalemic hypertension associated with accessional headache and a diagnosis of essential hypertension and left adrenal incidentaloma was made. After few years of well-controlled hypertension, blood pressure levels worsened and a significant cardiac remodeling and a second grade retinopathy appeared despite of the increased number of antihypertensive drugs. Hormone tests were then repeated and showed an elevated aldosterone to renin ratio with normal cortisol and catecholamines. Primary aldosteronism was confirmed by the lack of suppression of aldosterone levels after an intravenous saline loading test. Computerized tomography scanning confirmed the left adrenal adenoma that was increased respect to the previous evaluation. Successful adrenalectomy was performed, which resulted in a decrease of blood pressure and no need of antihypertensive drugs. This case-report confirms the need for an accurate diagnostic work-up for primary aldosteronism and a strict follow-up of patients with mild hypertension and apparently non-functioning adrenal adenoma.


Adrenal adenomas are occasionally found in patients with hypertension, a condition that rises the diagnostic problem to rule out a primary aldosteronism or other endocrine forms of secondary hypertension. Once exclusion of a functioning adenoma has been made by an extensive diagnostic work-up, there is no evidence on the correct timing for the follow-up of these patients. This case report confirms that patients with an apparently non-functioning adrenal adenoma can be at risk for developing resistant hypertension and target organ damage with the adenoma becoming functioning over time.

Case Presentation

A 44-year-old female was admitted to our Hypertension Unit for the evaluation of a resistant form of hypertension. The patient had been found to be hypertensive seven years before the present admission when she experienced a progressively worsening of a chronic headache associated with a mild hypertension. In that occasion, she did not report other associated symptoms including flushing, diaphoresis and palpitations, there was no family history of endocrine neoplasms or early cerebral and cardiovascular disease, but her mother was hypertensive too. She was a smoker of about 20 cigarettes/day but she had no other cardiovascular risk factors and a pregnancy occurred few years before was uncomplicated. After an adequate wash-out from anti-hypertensive drugs, urinary catecholamines, plasma Active Renin (AR), potassium and aldosterone levels, 24h urinary free cortisol, midnight serum cortisol and 1-mg overnight dexamethasone suppression test were all within the normal range. Abdominal Computerized Tomography (CT) scanning performed with the suspect of a pheochromocytoma detected the presence of a 16 mm mass inside the left adrenal gland. In that period, our laboratory did not perform metanephrines evaluation and the pheochromocytoma was further excluded by a negative metoclopramide stimulation test [1]. The assessment of hypertensive damage of heart, arteries, kidney and retina was negative. The patient was discharged in satisfactory blood pressure control with only amlodipine 5 mg/day and a diagnosis of essential hypertension and left adrenal incidentaloma was made. The patient did not continue the follow-up at our Hypertension Unit. (Table 1) summarizes laboratory tests and (Table 2) echocardiographic results. (Figure 1A) shows the CT image of the 16 mm left adrenal gland detected during the first evaluation.