Malignant hypertension after adrenalectomy

A 48-year-old Chinese presented with bilateral blurred vision, and was found to have accelerated hypertension and funduscopic manifestation of papilloedema. He had been diagnosed as having a left adrenal tumour 2 months previously, when he first reported anorexia and left upper quadrant pain. Computed tomography (Figure 1) and subsequent laparotomy excision revealed a large adrenocortical carcinoma characterized by moderate pleomorphism of tumour cells and mitosis. Preoperative investigation details were not known to the patient, who was thought to be normotensive at that time. He never reported paroxysmal palpitation or symptoms related to catecholamine excess. His plasma potassium level was 2.7mmol/l (normal range 3.5–5.1mmol/l), with a bicarbonate level of 29mmol/l and corresponding urinary potassium of 51mmol/l. Urinary cortisol and catecholamines were within normal range. Questions