Case 7

Image: adrenal adenoma

This patient was diagnosed with primary hyperaldosteronism following investigation for hypertension. He had this adrenal mass removed surgically, which was subsequently diagnosed as an adrenal adenoma.

Question 1

Which of the following are true about hypertension? (Tick all those that apply)

	a)	Most cases are primary (essential).
	b)	The commonest cause of secondary hypertension is a phaeochromocytoma.
	c)	It can lead to the development of Charcot-Bouchard aneurysms.
	d)	It is a common cause of acute renal failure.
Correct. Over 95% of all cases of hypertension are primary, with no clear underlying cause. The commonest cause of secondary hypertension is some form of chronic renal disease. Phaeochromocytomas account for a tiny (0.1%) proportion of all cases of hypertension. Hypertension weakens arterioles, and can lead to the development of microaneurysms in arterioles in the brain; rupture of these microaneurysms leads to spontaneous intracerebral haemorrhage and stroke. Hypertension can rarely cause acute renal failure if there is sudden sharp rise in blood pressure, but it is not a common cause of acute renal failure. Hypertension is, however, a common cause of chronic renal failure. Page reference: 72-5 Incorrect. Over 95% of all cases of hypertension are primary, with no clear underlying cause. The commonest cause of secondary hypertension is some form of chronic renal disease. Phaeochromocytomas account for a tiny (0.1%) proportion of all cases of hypertension. Hypertension weakens arterioles, and can lead to the development of microaneurysms in arterioles in the brain; rupture of these microaneurysms leads to spontaneous intracerebral haemorrhage and stroke. Hypertension can rarely cause acute renal failure if there is sudden sharp rise in blood pressure, but it is not a common cause of acute renal failure. Hypertension is, however, a common cause of chronic renal failure. Page reference: 72-5 Your answer has been saved.

Question 2

Which of the following are true? (Tick all those that apply)

	a)	Pre-operatively, the patient had hypokalaemia and hypernatraemia.
	b)	Pre-operatively, the plasma aldosterone:renin ratio would have been raised.
	c)	The patient is likely to still require lifelong antihypertensive treatment, albeit less aggressively.
	d)	If the tumour had secreted glucocorticoids, Cushing's syndrome would have occurred.
Correct. Primary hyperaldosteronism leads to increased reabsorption of sodium and water in the distal collecting tubules and collecting ducts of the kidney at the expense of potassium, leading to hypokalaemia and hypernatraemia. A high plasma aldosterone in the absence of a raised renin confirms Conn's syndrome in a patient suspected of having the diagnosis. Surgical removal of an adrenal adenoma is usually curative and most patients can stop all antihypertensive medication. Secretion of excess glucocorticoids by an adrenal adenoma can cause Cushing's syndrome. Page reference: 305-6 Incorrect. Primary hyperaldosteronism leads to increased reabsorption of sodium and water in the distal collecting tubules and collecting ducts of the kidney at the expense of potassium, leading to hypokalaemia and hypernatraemia. A high plasma aldosterone in the absence of a raised renin confirms Conn's syndrome in a patient suspected of having the diagnosis. Surgical removal of an adrenal adenoma is usually curative and most patients can stop all antihypertensive medication. Secretion of excess glucocorticoids by an adrenal adenoma can cause Cushing's syndrome. Page reference: 305-6 Your answer has been saved.

Carton, Daly & Ramani: Clinical Pathology - Case Studies

Table of Contents

Case 7

Question 1

Question 2