Abstract

31 year old male presented with sudden, painless, diminution of vision in both eyes since 3 days, associated with severe headache. His BP was 190/130 mmHg in left arm in left lateral position. His BCVA in right and left eye was 6/24 and 5/60 respectively. On fundus examination, both eyes showed grade IV papilledema with multiple peripapillary cotton wool spots with few flame shaped hemorrhages with absent foveal reflex suggestive of macular edema; diagnostic of malignant hypertension. OCT macula showed sub-foveal NSD with increased CMT. Patient was referred to medicine department for hypertensive crisis management and to investigate hypertension in young male, thyroid profile, ECG and renal USG with doppler was done. To our surprise, patient was diagnosed as malignant hypertension secondary to aldosterone producing adrenocortical carcinoma (ACC) which was confirmed on MRI and patient was refereed to oncosurgery department for further management.