PMC3134682_01
(A) CT of the abdomen with contrast demonstrates a 1-cm nodule in the right adrenal gland consistent with benign adenoma (arrow). (B) The same CT of the abdomen showing a normal left adrenal gland (arrow).
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F1
Two years before this presentation, she underwent a laparoscopic right adrenalectomy for a 1-cm hyperfunctioning right adrenal mass found on abdominal CT scan (Figure 1A) with a normal-appearing left adrenal gland (Figure 1B).
Histopathology (H&E, 100X) of right adrenal gland nodule after right adrenalectomy is consistent with APA.
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F2
Surgical pathology at the time revealed an adrenal cortical adenoma measuring 1cm x 1cm x 0.8cm consistent with aldosteronoma (Figure 2).
CT of the abdomen with contrast (2 years after right adrenalectomy) demonstrates a new 1.1-cm nodule with nonspecific characteristics in the left adrenal gland consistent with benign adenoma (arrow).
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F3
Follow-up CT scan revealed radiological features of a new 1.1-cm left adrenal nodule (Figure 3) and absent adrenal gland on a right side consistent with a new contralateral hyperfunctioning left adrenal adenoma.
(A) Left adrenal gland with 1.1-cm nodule (arrow) that was identified as an APA after left adrenalectomy 2 years after right adrenalectomy for right APA. (B) Histopathology (H&E, 100X) of the specimen is consistent with APA.
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F4
At this time, the patient underwent a laparoscopic left near total adrenalectomy for the new adrenal mass that was confirmed to be an adrenal cortical adenoma measuring 1cm x 0.7cm x 0.6cm (Figure 4).
Plasma aldosterone concentration (PAC) before and after right adrenalectomy, and 2 years after right adrenalectomy. An increase in PAC was evident 2 years after right adrenalectomy; the patient subsequently underwent left adrenalectomy for left APA, and postoperative PAC returned to normal.
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F5
Figure 5 demonstrates changes in the patient's PAC over the course of 2 years.