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🩺 #22 - Nocturia, Headaches and Raised Aldosterone
Haseeb Hamid
July 31, 2024
Nocturia, Headaches and Raised Aldosterone
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🗒️ Question
A 45 year old woman presents to clinic with a 3 year history of persistent hypertension that has been refractory to multiple antihypertensive medications. She also reports episodes of severe muscle weakness, frequent urination, nocturia and occasional headaches. She denies any history of chest pain, palpitations or sweating. Physical examination reveals a blood pressure of 160/100 mmHg and no significant findings on cardiovascular or abdominal examination.
Laboratory tests reveal the following results:
Serum potassium: 2.8 mmol/L (3.5-5.0)
Serum bicarbonate: 31 mmol/L (22-29)
Plasma renin activity: 0.2 pmol/L/s (2.8-4.4)
Serum aldosterone: 970 pmol/L (100-400)
Serum cortisol: 414 nmol/L (138-690) at 8 AM
24-hour urinary catecholamines: Normal
A CT scan shows a 2 cm adrenal mass on the left side.
What is the most likely diagnosis?
(A) Addison's disease
(B) Adrenal adenoma
(C) Conn's syndrome
(D) Phaeochromocytoma
(E) Renovascular hypertension