The most important hormonally-silent AA is pheochromocytoma. They should be considered in all AA cases because they are more common than previously thought, diagnosis is often overlooked, and failure to recognize them may lead to patient death. One series reported that less than one-quarter found at postmortem were diagnosed ante mortem. Many of the patients died of causes possibly related to the pheochromocytoma. Assume all AA have a pheochromocytoma until proven otherwise, especially when paroxysmal hyperadrenergic symptoms are present.
Primary hyperaldosteronism is a less compelling but nevertheless important diagnosis.
Surgical intervention can cure the hypertension and hypokalemia. It is usually identified by suppressed upright plasma renin and concomitant elevated plasma aldosterone. Other secreted hormones can include estrogens, androgens, and 17-hydroxyprogesterone. They are associated with adrenal adenomas, carcinomas, and hyperplasia. They often manifest clinically and therefore do not require presumptive screening.