C.P. is a 31-year-old student with a four year history of hypertension. Upon initial evaluation, her K was 2.9 mEq/L, and the possibility of primary aldosteronism was considered. Random serum renin and aldosterone levels were normal, however, and the issue was dropped. Her hypertension was not controlled during treatment with metoprolol, but she did respond favorably to treatment with Aldactazide. She later discontinued medications, her hypertension persisted and K was 3.0 mEq/L.

Physical examination, except for a BP of 185/102, was unremarkable. She did not have a cushingoid habitus.

Laboratory data:

• Na 146 (135-145 mEq/L) Cr 0.7 (<1.2 mg/dL)
• K 3.0 (3.5-5 mEq/L)
• C1 107 (95-110 mEq/L)
• CO2 27 (22-29 mEq/L)
• EKG nonspecific ST changes, strain

Na-loaded 24 hr urine:

• Na 220 (normal 27-287 mEq/L)
• K 100 (normal 26-123 mEq/L)
• Aldost. 45 ug(normal <5)
• Plasma Aldosterone
• random 62 ng/dl
• P 2L NS iv 49 ng/dl (normal <4)
• Plasma Renin activity
• supine <0.1
• upright p Lasix 0.1

CT adrenals -- 2 cm homogeneous mass R adrenal

She had surgical resection of the R adrenal mass through a flank incision.You are the pathologist, you observe this gross.

Your Diagnosis ?

The postoperative course was uncomplicated, and her BP and serum K on follow-up were normal.

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