Primary hyperaldosteronism secondary to right adrenal hyperplasia with non-functioning left adrenal adenoma elucidated by adrenal vein sampling: A case report with in-depth physiological review on utility of aldosterone renin ratio

Adam Tuchinsky; Sundus Sardar; Abdel-Rauof M Akkari; Ahmad Samir Matarneh; Gia Susan John; Nasrollah Ghahramani; Umar Farooq

doi:10.1002/ccr3.9206

Primary hyperaldosteronism secondary to right adrenal hyperplasia with non-functioning left adrenal adenoma elucidated by adrenal vein sampling: A case report with in-depth physiological review on utility of aldosterone renin ratio

Clin Case Rep. 2024 Oct 14;12(10):e9206. doi: 10.1002/ccr3.9206. eCollection 2024 Oct.

Authors

Adam Tuchinsky¹, Sundus Sardar^{2

3

4}, Abdel-Rauof M Akkari^{2

3}, Ahmad Samir Matarneh^{2

3}, Gia Susan John⁵, Nasrollah Ghahramani^{2

3}, Umar Farooq^{2

3}

Affiliations

¹ UPMC Pinnacle Lititz Lititz Pennsylvania USA.
² Penn State College of Medicine Hershey Pennsylvania USA.
³ Penn State Health Milton S Hershey Medical Center Hershey Pennsylvania USA.
⁴ ECPE, Harvard T.H. Chan School of Public Health Boston Massachusetts USA.
⁵ Cumberland Valley High School Mechanicsburg Pennsylvania USA.

Abstract

In cases of primary hyperaldosteronism, the aldosterone renin ratio (ARR) is crucial for determining the need for adrenal vein sampling (AVS). Our case highlights the importance of utilizing ARR with AVS, contextual interpretation of plasma renin and aldosterone levels, and stresses that sole reliance on imaging without AVS may result in unnecessary or contralateral adrenalectomy.

Keywords: adrenal adenoma; adrenal hyperplasia; adrenal vein sampling; aldosterone renin ratio; hypertension; primary hyperaldosteronism.