A 45-year-old man presented with muscle weakness and a history of hypertension. Laboratory investigations revealed hypokalemia. Further endocrine evaluation demonstrated an elevated serum aldosterone concentration, raising suspicion for primary hyperaldosteronism.
Abdominal computed tomography (CT) was performed as part of the evaluation and demonstrated a left adrenal mass measuring approximately [22 × 15] mm. The radiologic characteristics were suggestive of an adrenal adenoma. Interestingly, imaging also revealed a separate solid mass in the left kidney measuring approximately [35 × 30] mm, suspicious for renal cell carcinoma.
Considering the biochemical findings, clinical presentation, and imaging characteristics, the adrenal lesion was considered a functioning aldosterone-producing adrenal adenoma. The ipsilateral renal mass was independently considered suspicious for a primary renal malignancy.
After multidisciplinary evaluation and appropriate preoperative management of hypokalemia and hypertension, the patient underwent simultaneous laparoscopic surgery. A laparoscopic left adrenalectomy was performed together with left partial nephrectomy during the same operative session.
The procedure was completed laparoscopically without conversion to open surgery. The postoperative course was uneventful, and the patient was discharged on postoperative day 3.
Histopathological examination of the adrenal specimen confirmed an adrenal cortical adenoma, with no evidence of malignancy. Examination of the renal specimen revealed clear cell renal cell carcinoma (clear cell RCC), measuring [2.5] cm in greatest dimension. Surgical margins were free of tumor, and the pathological stage was pT1a.
Thus, the final diagnosis was a synchronous aldosterone-producing left adrenal cortical adenoma and ipsilateral clear cell renal cell carcinoma.
Following adrenalectomy, the patient's serum potassium level returned to the normal range without potassium supplementation. His blood pressure also normalized, with discontinuation of antihypertensive medications.
At 12-month follow-up, the patient remained clinically well, with no evidence of recurrent renal malignancy on follow-up evaluation.
Mehdi Dadpour, Assistant Professor of Urology
Labbafinejad medical Center, The Center of Excellence in Urology