{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:55Z","timestamp":1784557075191,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>\n                      We describe a case of a 42-year-old gentleman, 5 years post-transsphenoidal surgery (TSS) for pituitary-dependent Cushing\u2019s disease, initially presenting with malignant hypertension. Despite an initial improvement in his blood pressure post-TSS, he was found to be persistently hypertensive on follow-up despite no clinical or biochemical evidence of recurrence of hypercortisolism. His blood pressure remained elevated despite five antihypertensive agents. His renin concentration was &lt;5 mIU\/L (9\u2013103.5) and aldosterone concentration was 877 pmol\/L (0\u2013670). A subsequent CT of the adrenals showed a 1.2 cm left adrenal nodule. He was not suitable for adrenal vein sampling (AVS) at this time due to difficult-to-control hypertension. Biochemistry was difficult to interpret in the context of a multitude of interfering medications, which were necessary given his difficult-to-control hypertension and hypokalaemia. Once suitable, his initial AVS was unsuccessful due to failure to cannulate the right adrenal vein. He was given the further options of repeat AVS vs\n                      <jats:sup>11<\/jats:sup>\n                      C-metomidate PET vs medical management of his blood pressure. He proceeded with a repeat AVS, with successful cannulation of both adrenal veins. This showed evidence of hyperaldosteronism on the left side, with a lateralisation index of 39.5 and a contralateral suppression index of 0.28. He proceeded with a robotic left adrenalectomy, leading to significant improvement in his blood pressure, dropping from a mean reading of 142\/85 during daytime and 150\/88 mmHg at nighttime on five antihypertensive agents to normotensive levels of 114\/77 mmHg on two agents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>It is important to consider a broad differential for uncontrolled hypertension.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>It must be considered that patients can present with multiple, isolated endocrinopathies.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>There are diagnostic challenges with primary aldosteronism, with medication regimens regularly effecting suitability of testing and interpretation of results.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>AVS can be a challenging procedure, leading to diagnostic challenges in the lateralisation of primary aldosteronism; however, it or another form of lateralisation is essential to guide management options.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-24-0137","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:46:58Z","timestamp":1740120418000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Resistant hypertension post-transsphenoidal surgery for pituitary Cushing\u2019s disease, leading to a diagnosis of primary aldosteronism"],"prefix":"10.1530","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7169-1974","authenticated-orcid":true,"given":"Jack","family":"Lee","sequence":"first","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tomkins","sequence":"additional","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darran","family":"McDonald","sequence":"additional","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Martin-Grace","sequence":"additional","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Carthy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Finnegan","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Mulholland","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Dugal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold D K","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Surgery, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Sherlock","sequence":"additional","affiliation":[{"name":"Academic Division of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland"},{"name":"Department of Endocrinology, Beaumont Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Curr Opin Endocr Metab Res","first-page":"30","article-title":"The prevalence of primary aldosteronism and evolving approaches for treatment","volume":"8","author":"Yozamp N","year":"2019","unstructured":"Yozamp N\n & \nVaidya A\n\n. 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