Abstract: SA-PO0983
Adrenal Venous Sampling-Guided Diagnosis of Unilateral Primary Aldosteronism in a Kidney Transplant Recipient with ADPKD and No Radiologic Lesion
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Simpson, Samuel, The University of Toledo Medical Center, Toledo, Ohio, United States
- Chang, Yoon-Jung, The University of Toledo Medical Center, Toledo, Ohio, United States
- Wainstein, Matthew D, The University of Toledo Medical Center, Toledo, Ohio, United States
- Charette, Megan, The University of Toledo Medical Center, Toledo, Ohio, United States
- Ekwenna, Obi Davis, The University of Toledo Medical Center, Toledo, Ohio, United States
Introduction
Primary hyperaldosteronism, most often due to aldosterone producing adenoma, accounts for approximately 10% of secondary hypertension and carries a risk of cardiovascular risk unrecognized. Radiographic detection of adrenal lesion typically precedes biochemical confirmation and imaging maybe falsely negative in a third of the cases. Adrenal venous sampling remains the gold standard diagnostic tool to lateralize aldosterone secretion when cross-sectional imagings fail to reveal a mass. We describe a renal transplant recipient with autosomal dominant polycystic kidney disease (ADPKD), whose treatment resistant hypertension was ultimately traced to a unilateral aldosteronoma, despite unremarkable imaging.
Case Description
This report follows a previously published case of a 71-year-old male with a history of hypertension, autosomal dominant polycystic kidney disease (ADPKD), and end-stage renal disease (ESRD) post-renal transplantation. This individual was initially evaluated for renal transplantation in April 2023 and underwent successful renal transplantation in May 2023, however soon developed chronic allograft dysfunction with persistent treatment-resistant hypertension resulting in multiple admissions for hypertensive emergencies. An extensive workup was initiated, after which he underwent computed tomography (CT) followed by plasma aldosterone to renin ratio test with a value of 36. Imaging was unremarkable and did not detect an adrenal mass, yet given the significant ARR, this prompted subsequent adrenal venous sampling with corticotropin stimulation. This showed lateralization of aldosterone secretion with levels of 12.8 ng/dL in the right adrenal vein and 60.5 ng/dL in the left, confirming hyperaldosteronism secondary to a left adrenal aldosteronoma. The patient proceeded with robotic left adrenalectomy and showed significant resolution of hypertensive episodes and underwent a second renal transplant a month later.
Discussion
In transplant recipients with ADPKD and refractory hypertension, a negative adrenal CT should not preclude further evaluation. Adrenal venous sampling remains indispensable for definitive lateralization, diagnosis, and treatment of aldosteronoma even in the ESRD and transplant setting.