PMC8498213_01
Imaging, histology, and genetic studies of left and right aldosterone-producing-adenomas. (A) Adrenal computed tomography scans according to year of acquisition: a. 2004; b. 2014; c. 2017. The arrows indicate the adrenal adenoma with the largest diameter. Hematoxylin-eosin (HE) staining and immunohistochemistry (see Document, 
Supplemental Digital Content 1
, which describes detailed methods) of (B) left and (C) right aldosterone-producing adenomas: a, d. HE staining; b, e. CYP11B2 immunohistochemical staining of aldosterone synthase; c, f. immunohistochemical staining of KCNJ5. Black scale bar=2mm; white scale bar=100mum. CYP11B2, aldosterone synthase; KCNJ5, G-protein-coupled inwardly rectifying potassium channel. (D) Sanger DNA sequences of mutations in KCNJ5 gene and corresponding amino-acid change (see Document, 
Supplemental Digital Content 1
): a. Left APA: c. 451G>A, p.G151R; b. Right APA: c. 451G>C, p.G151R.
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An adrenal computed tomography (CT) scan showed a left 2.0 x 1.5-cm nodule ( Figure 1A , image a). The resected adrenal gland contained a 2.0 x 2.0-cm APA, which was immediately confirmed by hematoxylin and eosin (HE) staining ( Figure 1B , slide a) and again in 2020 by CYP11B2 staining ( Figure 1B , slide b). Meanwhile, the adrenal CT scan revealed a 1.6 x 1.6-cm nodule on the right adrenal gland, which had not been present in 2004 ( Figure 1A , image b). The resected adrenal gland measured 2.5 x 2.5 x 2.0 cm and was confirmed by HE and CYP11B2 staining to contain a 1.5 x 1.5 x 0.3 cm APA ( Figure 1C , slides a and b). She was then administered candesartan (8 mg QD) and carvedilol (10 mg QD), and her BP was maintained at approximately 120/80 mmHg.  Figure S1  illustrated a timeline with relevant data retracing the different steps of diagnosis and treatment of primary aldosteronism from 2004 to 2021. The results showed that both adenomas carried mutations in the KCNJ5 gene G151R with different base changes (Left: c.451G > A; Right c.451G > C) ( Figure 1D , graphs a and b). The immunostaining of KCNJ5 were decreased in the CYP11B2-positive stained adenomas ( Figure 1B  slide c;  Figure 1C , slide c).