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Recurrence of primary aldosteronism 20 years after surgery: a case report

Journal of Human Hypertension volume 39, pages 237–239 (2025)Cite this article

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Primary aldosteronism (PA) is characterized by excessive autonomous secretion of aldosterone from the adrenal cortex zona glomerulosa, resulting in sodium retention, potassium excretion, increased blood pressure (BP), and suppressed plasma renin activity. Clinically, it primarily manifests as hypertension with a proportion affected by hypokalemia. Compared to primary hypertension, patients with PA have a significantly higher risk of cardiovascular events, target organ damage (such as left ventricular hypertrophy), metabolic syndrome, and diabetes [1]. Aldosterone-producing adenoma (APA) accounts for about one-third of PA cases. Currently, guidelines recommend unilateral adrenal gland resection for patients diagnosed with APA [2]. Studies have shown that nearly all (96–100%) patients with unilateral PA can achieve a biochemical cure (i.e., normalization of plasma aldosterone levels) after adrenal gland resection [3]. PASO studies have also shown that unilateral PA can achieve a biochemical cure rate of 94% after adrenalectomy [4], but the clinical cure effect varies greatly. Here, we report a rare case of a young female patient diagnosed with PA 20 years ago, who underwent right adrenal adenoma resection and experienced a recurrence of PA 20 years after surgery, with a recurrence of the adenoma in the contralateral adrenal gland.

In June 2022, she experienced poor blood pressure control, fatigue, and palpitations. Self-measured BP was over 190/110 mmHg. After taking losartan potassium and metoprolol to control BP, BP still fluctuates between 160/90 mmHg. In July 2022, she was referred to our hospital, where a cardiac ultrasound indicated thickening of the basal segment of the interventricular septum. Follow-up enhanced CT of the adrenal gland revealed a left adrenal adenoma, approximately 1.7 × 1.5 cm (Fig. 1g, h). After two weeks of using verapamil to lower BP, the standing plasma renin activity was 0.2 ng/ml/h, the standing plasma aldosterone was 193.0 pg/ml, the ARR was 96.5, the serum potassium level was 3.94 mmol/L, serum sodium level was 141 mmol/L, creatinine was 51 ummol/L, and the urine microalbumin/urine creatinine ratio was 60.06 ug/mg. The further supine saline infusion test showed no significant aldosterone suppression, with a post-saline aldosterone level of 71.7 pg/ml (with the normal reference range being below 50 pg/ml). Further adrenal venous sampling (AVS) was attempted. Unfortunately, AVS catheterization was not successful. Considering the patient’s clinical presentation, imaging results, and willingness for surgery, surgical treatment was still chosen. The patient underwent left adrenal adenoma resection on August 9, 2022. Pathology results indicated a left adrenal cortical adenoma with focal cortical adenomatous hyperplasia (Fig. 1i, j). Postoperatively, we extracted DNA from peripheral blood and tumor tissue slices of the patient from the 2022 surgery for NGS and Sanger sequencing but did not find any known germline or somatic gene mutations. And, in the postoperative period, her serum potassium levels returned to normal, and antihypertensive medication was adjusted to metoprolol succinate sustained-release tablets 0.5 tablet Qd. BP fluctuated around 110–130/70–90 mmHg.The follow-up MRI results six months after surgery were normal (Fig. 1k, l).

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Fig. 1: Preoperative and postoperative imaging and pathological images of left and right adrenal adenoma resection.

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Data sharing does not apply to this article as no new data were created or analyzed in this study.

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Acknowledgements

We sincerely thank the patient for her cooperation in this case report, she signed the informed consent form and agreed to publication. We also appreciate the financial support from the Henan Province Medical Science and Technology Project (LHGJ20210016).

Funding

Henan Medical Science and Technology Research Project (LHGJ20210016).

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Author notes

  1. These authors contributed equally: Jie Wang, Cai-Ni Fan.

Authors and Affiliations

  1. Department of Hypertension, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, China

    Jie Wang, Cai-Ni Fan, Xiao-Jian Zhao, Kai Liu, Meng-Lin Wang, Ling Li, Min Liu & Hai-Ying Zhao

  2. Department of Hypertension, Gongyi People’s Hospital, Gongyi, Henan, 451200, China

    Guo-Xi Wei

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Contributions

Jie Wang: Data curation; Writing-original draft; Investigation. Cai-Ni Fan: Data curation; Investigation; Formal analysis; writing review & editing. Guo-Xi Wei: Data curation; Investigation. Xiao-Jian Zhao: Data curation; Investigation; Supervision. Kai Liu: Data curation; Investigation; Supervision. Meng-Lin Wang: Data curation; Investigation; Supervision. Ling Li: Supervision; Writing-review & editing. Min Liu: Investigation; Writing-review & editing. Hai-Ying Zhao: Funding acquisition;Investigation; writing-review & editing.

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Correspondence to Cai-Ni Fan or Hai-Ying Zhao.

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Wang, J., Fan, CN., Wei, GX. et al. Recurrence of primary aldosteronism 20 years after surgery: a case report. J Hum Hypertens 39, 237–239 (2025). https://doi.org/10.1038/s41371-025-00994-x

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