Case Report A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma Mario Molina-Ayala, 1 Claudia Ramírez-Rentería, 2 Analleli Manguilar-León, 1 Pedro Paúl-Gaytán, 1 and Aldo Ferreira-Hermosillo 1 1 Endocrinology Department, Hospital de Especialidades, Centro M´ edico Nacional Siglo XXI, IMSS, Cuauht´ emoc 330, Colonia Doctores, 06720 Mexico City, DF, Mexico 2 Experimental Endocrinology Investigation Unit, Hospital de Especialidades, Centro M´ edico Nacional Siglo XXI, IMSS, Cuauht´ emoc 330, Colonia Doctores, 06720 Mexico City, DF, Mexico Correspondence should be addressed to Aldo Ferreira-Hermosillo; aldo.nagisa@gmail.com Received 2 March 2015; Revised 5 June 2015; Accepted 9 June 2015 Academic Editor: Carlo Capella Copyright © 2015 Mario Molina-Ayala et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of diferent endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental let adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m- MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography conirmed a let adrenal tumor of 20 cm. he patient underwent parathyroidectomy and adrenalectomy with inal pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and inally died less than one year later. 1. Introduction Primary hyperparathyroidism due to multiple gland hyper- plasia is the most common presentation of parathyroid disease in patients with multiple endocrine neoplasia type 1 (MEN1), which also includes pituitary tumors (mostly prolactinomas) and tumors in endocrine pancreas and duo- denum. However, other gastroenteropancreatic neuroen- docrine tumors, adrenocortical adenomas, or thyroid nod- ules can occur in MEN1 [1]. Almost 50% of MEN1 patients could develop adrenal adenomas or hyperplasia, which are mainly nonfunctioning and benign [2]. Adrenocortical car- cinomas (ACC) are rare manifestations of MEN1 with an incidence of 6% according to Waldmann et al. [2]. In fact, less than 1% of ACC produce aldosterone, cortisol, or androgens. Aldosterone-producing adrenocortical carcinomas (APAC) are infrequent but are highly aggressive and recurrent [3] and could evolve from initially small and clinically nonfunctional adenomas. he purpose of this paper is to report an unusual association of primary hyperparathyroidism with an APAC that supports the need for extensive endocrinological assess- ments in patients with adrenal carcinomas and any atypical presentation of neuroendocrine disease. 2. Case Report A 40-year-old man presented with a 4-year history of hyper- tension treated with aldosterone receptor antagonist (ARA2) and in 2008 a let lithotripsy. He had a family history of type 2 diabetes and cancer (type not speciied). He presented Hindawi Publishing Corporation Case Reports in Endocrinology Volume 2015, Article ID 910984, 5 pages http://dx.doi.org/10.1155/2015/910984