Ectopic Adrenocortical Adenoma Causing Malignant Hypertension and Hypokalemia

BACKGROUND Ectopic adrenocortical adenomas are rare and can produce aldosterone autonomously, causing resistant hypertension and hypokalemia. Atypical locations pose diagnostic challenges. This report describes a 45-year-old man with malignant hypertension and hypokalemia due to an aldosterone-producing ectopic adrenal adenoma located between the pancreas and left adrenal gland. CASE REPORT A 45-year-old man with a 9-year history of poorly controlled hypertension presented with dizziness, vomiting, and fatigue. On admission, blood pressure was 192/110 mmHg and serum potassium was 2.07 mmol/L. Physical examination revealed left ventricular hypertrophy and hypertensive end-organ damage. Laboratory test results showed elevated plasma aldosterone (47.61 ng/dL) and suppressed renin (0.04 ng/mL/h), yielding an aldosterone-to-renin ratio of 1190. Abdominal CT and MRI identified a 3-cm solid cystic mass between the pancreatic tail and lateral branch of the left adrenal gland. Cortisol circadian rhythm, dehydroepiandrosterone sulfate, and plasma metanephrines were within normal limits, excluding other functional adrenal tumors. The patient underwent complete surgical resection of the ectopic adrenal adenoma. Histopathology confirmed adrenal cortical adenoma with focal adrenal medullary hyperplasia. At 1-year follow-up, he had normal blood pressure and serum potassium levels on an antihypertensive regimen. CONCLUSIONS This case highlights a rare ectopic aldosterone-producing adrenal adenoma near the pancreas. A thorough biochemical and imaging workup was essential for diagnosis, and surgical resection achieved clinical resolution. Ectopic adrenal tumors should be considered in the differential diagnosis of resistant hypertension with hypokalemia when standard adrenal imaging is inconclusive.