69-year-old male who presented with long standing uncontrollable hypertension,  hypokalemia, hyperaldosteronism. CT of the abdomen showed bilateral adrenal masses with the left 4.6×3.3 cm  and the right 4.4×2.5 cm. He had extensive biochemical evaluation including : serum catecholamines on multiple occasions that were normal, 24 hr urine studies that showed normal cortisol. Aldosterone levels were elevated on a number of occasions. He had two EGD for dysphagia and two gastrinomas were found in duodenal polyps. Other history includes: Iron deficient anemia, diabetes mellitus, left hemithyroidectomy for thyroid adenoma.

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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan