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Case presentation

Case presentation . A 52 y/o Female with Hypertension and Bilateral Adrenal Masses Presented by: A.H. Ghanooni M.D fellow of Endocrinology Endocrine Research Institute, SBMU. Present illness. A 52 year-old married female, housewife, from Tehran, presented with hypertension since 6 years ago.

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Case presentation

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  1. Case presentation A 52 y/o Female with Hypertension and Bilateral Adrenal Masses Presented by: A.H. Ghanooni M.D fellow of Endocrinology Endocrine Research Institute, SBMU

  2. Present illness • A 52 year-old married female, housewife, from Tehran, presented with hypertension since 6 years ago. • She was usually well controlled initially after start medication (single beta-blocker = atenolol). • She has had several hypertension crisis specially after emotional stress. • she has had headache and nausea during episodes. • no sweating, palpitation, flushing during these episodes. • No history of weight change, weakness, easy bruising, tremor, diaphoresis, heat intolerance, hirsutism and acnea.

  3. 1392 • After 2 years, she had been referred to gynecologist because of spotting and abdominopelvic pain. • After taking a CT scan for this reason, incidentally bilateral adrenal lesions was seen and she was referred to endocrinologist.

  4. CT scan

  5. 92/4 • By endocrinologist, laboratory tests for adrenal incidentaloma and secondary cause of hypertension was requested.

  6. 92/5

  7. 92/6 CT scan without IV contrast 92/6

  8. CT scan with contrast 92/6

  9. CT scan with contrast 92/6

  10. 92/6

  11. 93/12

  12. 96/3/6

  13. Past Medical & Surgical Hx • AUB and uterine leiomyoma • surgery on uterus for leiomyoma • Depression • Fibromyalgia • IBS • Anal fissure • DM (-)

  14. FHx • HTN in her mother and sister in middle ages. • Her mother was dead because of renal cancer • Diabetes in her sister • Brain tumor in her sister • Hysterectomy in her sister because of probably uterine malignancy • Multiple Sclerosis in her daughter

  15. DHx • Bisoprolol (concor) 5mg ½ bid • Indapamide (NATRILIX SR) 1.5mg daily • Losartan 25mg bid • Gabapentin 100mg bid • Duloxetine 20mg daily • Clonazepam 1mg daily • Pantoprazol 20mg daily

  16. Review of Systems • No Fever, anorexia and weight loss • bilateral and tension headache after waking up • Flatulence and Abdominal pain after eating meals and relieve after defication and severe constipation and intermittent mucoid diarrhea. • Depressive mood,

  17. Physical Examinations • H : 152 cm • W : 82 kg • BMI : 35.4 • HR : 84 /min • BP : 135/90 mmHg Rt hand • BP : 120/85 mmHg Lt hand

  18. Physical Examinations • Moon face (–) • Dorsocervical fat pad (–) Supraclavicular fullness(-) • Abdominal distension, no steria, No tenderness, no organomegaly, • point tenderness in special locus for fibromyalgia

  19. Problem list • 52 y/o lady • Hypertension since 6 y ago • Bilateral adrenal lesions • Borderline laboratory findings ( upper limit of normal UFC, suppressed ACTH) • Different BP measurement in both upper limbs • Abdominal pain and distension with constipation and intermittent diarrhea • Depressive mood, and point tenderness in special locus for fibromyalgia

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