Case History and Physical Examination

A 65-year-old man diagnosed with hypertension for the past 20 years occasionally experienced palpitations. His recent blood pressure measurements ranged from 140/80 mmHg to 160/80–95 mmHg, and his heart rate was between 85 and 105 bpm. His blood pressure was controlled by amlodipine (10 mg daily) and doxazosin (2 mg daily). Multiphasic CT revealed a 1 cm left adrenal tumor (Fig. 1a).

Left adrenal tumor in a 60-year-old man with primary hyperaldosteronism a Dynamic CT section through the left adrenal gland demonstrates a slightly enhancing nodule, 1 cm in diameter (arrow), in the left adrenal gland. b Digital subtraction of left adrenal venogram demonstrates the left adrenal and tributary veins. A capsular vein is filled, but the inferior phrenic vein is not due to the valve at its junction with the adrenal vein. A bent section can be confirmed on the central side of the superior lateral tributary vein (arrowhead). c, d Volume rendering (VR) image obtained on dynamic CT showing the main trunk of the adrenal vein and tributary veins (purple), the left renal vein (cyan), an adrenal tumor (green), the left adrenal gland (yellow), and the left kidney (brown). The left anterior and right anterior oblique views on the VR images show a superior lateral tributary vein located adjacent to the adrenal tumor (arrow)