An incidentaloma is an abnormality that is found during an investigation for something else. In the case of a CT scan that identified a small cyst on a patient’s left adrenal gland, the patient has suffered from hypertension for over 20 years. The question is whether the cyst could be responsible for high blood pressure. Adrenal glands produce various hormones, including adrenaline and cortisol. Growths can form on these glands which are usually benign but can also produce hormones that cause health issues, and hypertension is a possible symptom. Excess levels of cortisol cause blood vessels to contract, which increases blood pressure, and adrenal growths can also produce aldosterone. This hormone increases the body’s sodium retention, which causes fluid retention and raised blood pressure. Research suggests that adrenal masses 2mm to 40mm in size are found in 12% of people with hypertension. While high blood pressure without any underlying lifestyle factors is unusual, age and genetics can also play a role. Patients with symptoms should have tests to check on the status of the adrenal growth, and a blood test can reveal high hormone levels. If checks have not been done, the patient should ask their GP and get referred to an endocrinologist if necessary. Treatment for adrenal growth is adrenalectomy, which is the removal of the adrenal gland with keyhole surgery. Patients can live perfectly well with just one gland. The earlier the diagnosis, the better the outcome for the patient.
Dry mouth, a side-effect of medication for bipolar disorder, is a common symptom that can cause discomfort and inconvenience. Medications for bipolar disorder have been known to cause dry mouth, including Prozac, lithium, and lamotrigine, which the patient has been taking. Dry mouth could be drug-related, but it is important to consider the medical cause. If the patient has a constant dry mouth, Sjogren’s syndrome is a possibility. This autoimmune disorder causes the immune system to attack the salivary glands and the eyes, leading to dry eyes and mouth, and is most common in women over 40. Lithium is known to cause hypothyroidism, where the thyroid gland does not produce enough thyroxine hormone, which is associated with dry mouth and a hoarse voice. A doctor should check the patient’s thyroid function to determine if hypothyroidism is a factor. Saliva tests, tear production tests, blood tests, and a biopsy from inside the mouth are necessary to diagnose Sjogren’s Syndrome. If this diagnosis is not confirmed, then it could be a side-effect of medication. Patients should be aware that most antidepressants list dry mouth as a potential side-effect, but the anticonvulsant lamotrigine is a good option. Dry mouth is far less likely with lamotrigine, and effective treatment for bipolar disorder remains very important.
In conclusion, patients should be aware of the possibility of an incidentaloma, which can cause hypertension as a symptom. It is important to keep a check on the status of the adrenal growth, which can be done by a blood test. Patients should also be aware of the symptoms of a hormonal disorder like Sjogren’s Syndrome, which can cause dry mouth as a symptom. This autoimmune disorder can be diagnosed through a series of tests, including a biopsy. Effective treatment for bipolar disorder is crucial, and patients should be aware that certain medications can cause dry mouth as a side-effect.
