Adrenal vein sampling in bilateral adrenal tumors with autonomous hypercortisolism

Abstract

Bilateral adrenal tumors are a rare pathology, increasingly detected due to the widespread use of diagnostic imaging procedures such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These changes can be either malignant or benign, with the potential for autonomous hormone production. Historically, tuberculosis was a leading cause of bilateral adrenal changes due to lower socio-economic status and poor hygiene. In this case, the patient was diagnosed with hypertension at 38 years old, and initial considerations included secondary endocrine causes of hypertension, specifically primary aldosteronism. CT imaging revealed bilaterally enlarged adrenal glands with multiple nodular changes showing absolute and relative washout indices characteristic of adenomas, with the largest measuring 17 x 23 mm on the right and 21 x 23 mm on the left. The patient had a history of hypokalemia, with the lowest recorded potassium level being 3.3 mmol/L. She reported spontaneous bruising on her arms and legs and weight gain in the abdominal area. Testing indicated the presence of ACTH-independent hypercortisolism. To precisely localize cortisol hypersecretion, adrenal vein sampling (AVS) was performed.