Functioning or Non-Functioning Adrenal Adenoma? Probably, Just a Matter of Time

We present a 44-year-old female with an adrenal adenoma characterized by late autonomous secretion of aldosterone. The patient was admitted at our Hypertension Unit for a resistant form of severe hypertension with target organ damage and a history of adrenal non-functioning adenoma. Seven years before admission, the patient was evaluated for a mild normokalemic hypertension associated with accessional headache and a diagnosis of essential hypertension and left adrenal incidentaloma was made. After few years of well-controlled hypertension, blood pressure levels worsened and a significant cardiac remodeling and a second grade retinopathy appeared despite of the increased number of antihypertensive drugs. Hormone tests were then repeated and showed an elevated aldosterone to renin ratio with normal cortisol and catecholamines. Primary aldosteronism was confirmed by the lack of suppression of aldosterone levels after an intravenous saline loading test. Computerized tomography scanning confirmed the left adrenal adenoma that was increased respect to the previous evaluation. Successful adrenalectomy was performed, which resulted in a decrease of blood pressure and no need of antihypertensive drugs. This case-report confirms the need for an accurate diagnostic work-up for primary aldosteronism and a strict follow-up of patients with mild hypertension and apparently non-functioning adrenal adenoma.