Abstract
A 35-year-old Japanese woman was referred for further examination of persistent hypertension with hypokalemia. Her serum aldosterone levels were high and her plasma renin activity markedly suppressed. Radiological examinations revealed the presence of a 3-cm diameter left adrenal tumor. 131I-adosterol was specifically accumulated in the left adrenal tumor, whereas the accumulation in the right adrenal was completely suppressed. Low-dose dexamethasone failed to suppress cortisol secretion although the serum cortisol levels were within the normal range. Urinary excretion of 17-hydroxycorticosteroids but not 17-ketosteroids was increased. Levels of plasma adrenocorticotropin (ACTH) and serum dehydroepiandrosterone sulfate (DHEAS) were decreased. Upon diagnosis of left aldosteronoma with autonomous secretion of cortisol, left adrenalectomy was performed by laparoscopy. In the resected adenoma tissues, clear cells expressed P450c17 protein and the ratio of CYP17/CYP11B2 mRNA evaluated by quantitative real-time polymerase chain reaction (PCR) was apparently higher than that of typical aldosteronomas. Based on the corticotropin-releasing hormone (CRH) loading tests, the contra-lateral adrenal functions were restored 3 months after surgery. These results indicate that evaluation for autonomy of cortisol secretion and contra-lateral adrenal function is clinically important to avoid the risk of adrenal failure after surgery for primary aldosteronism.
Similar content being viewed by others
Article PDF
References
Stowasser M, Gordon RD : Primary aldosteronism. Best Pract Res Clin Endocrinol Metab 2003; 17: 591–605.
Otsuka F, Otsuka-Misunaga F, Koyama S, et al: Hormonal characteristics of primary aldosteronism due to unilateral adrenal hyperplasia. J Endocrinol Invest 1998; 21: 531–536.
Miyoshi T, Otsuka F, Ogura T, et al: Aldosterone regulation for 18 years in a case of primary aldosteronism. Am J Hypertens 2004; 17: 546–548.
Yokota K, Ogura T, Kishida M, et al: Japanese family with glucocorticoid-remediable aldosteronism diagnosed by long-polymerase chain reaction. Hypertens Res 2001; 24: 589–594.
Hogan MJ, Schambelan M, Biglieri EG : Concurrent hypercortisolism and hypermineralocorticoidism. Am J Med 1977; 62: 777–782.
Baert D, Nobels F, Van Crombrugge P : Combined Conn's and Cushing's syndrome: an unusual presentation of adrenal adenoma. Acta Clin Belg 1995; 50: 310–313.
Hobma S, Hermus A, Pieters G, Smals A, Kloppenborg P : Concurrent hypercortisolism and hyperaldosteronism due to an adrenal adenoma. Klin Wochenschr 1990; 68: 981–983.
Katabami T, Obi R, Shirai N, Naito S, Saito N : Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome. Endocr J 2005; 52: 463–469.
Inagaki K, Otsuka F, Suzuki J, et al: Involvement of bone morphogenetic protein-6 in differential regulation of aldosterone production by angiotensin II and potassium in human adrenocortical cells. Endocrinology 2006; 147: 2681–2689.
Komiya I, Koizumi Y, Kobayashi R, et al: Concurrent hypersecretion of aldosterone and cortisol from the adrenal cortical adenoma. Am J Med 1979; 67: 516–518.
Imai T, Seo H, Murata Y, Funahashi H, et al: Dexamethasone-nonsuppressible cortisol in two cases with aldosterone-producing adenoma. J Clin Endocrinol Metab 1991; 72: 575–581.
Allan CA, Kaltsas G, Perry L, et al: Concurrent secretion of aldosterone and cortisol from an adrenal adenoma—value of MRI in diagnosis. Clin Endocrinol (Oxf) 2000; 53: 749–753.
Honda T, Nakamura T, Saito Y, et al: Combined primary aldosteronism and preclinical Cushing's syndrome: an unusual case presentation of adrenal adenoma. Hypertens Res 2001; 24: 723–726.
Makino S, Oda S, Saka T, et al: A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone. Endocr J 2001; 48: 103–111.
Tanaka M, Izeki M, Miyazaki Y, et al: Combined primary aldosteronism and Cushing's syndrome due to a single adrenocortical adenoma complicated by Hashimoto's thyroiditis. Intern Med 2002; 41: 967–971.
Sugawara A, Takeuchi K, Suzuki T, et al: A case of aldosterone-producing adrenocortical adenoma associated with a probable post-operative adrenal crisis: histopathological analyses of the adrenal gland. Hypertens Res 2003; 26: 663–668.
Fujii H, Kamide K, Miyake O, et al: Primary aldosteronism combined with preclinical Cushing's syndrome in an elderly patient. Circ J 2005; 69: 1425–1427.
Emral R, Uysal AR, Asik M, et al: Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocr J 2003; 50: 399–408.
Adachi J, Hirai Y, Terui K, et al: A report of 7 cases of adrenal tumors secreting both cortisol and aldosterone. Intern Med 2003; 42: 714–718.
Nagae A, Murakami E, Hiwada K, et al: Primary aldosteronism with cortisol overproduction from bilateral multiple adrenal adenomas. Jpn J Med 1991; 30: 26–31.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suzuki, J., Otsuka, F., Inagaki, K. et al. Primary Aldosteronism Caused by a Unilateral Adrenal Adenoma Accompanied by Autonomous Cortisol Secretion. Hypertens Res 30, 367–373 (2007). https://doi.org/10.1291/hypres.30.367
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.30.367
Keywords
This article is cited by
-
Difficult-to-control hypertension due to bilateral aldosterone-producing adrenocortical microadenomas associated with a cortisol-producing adrenal macroadenoma
Journal of Human Hypertension (2011)
-
Sporadic solitary aldosterone- and cortisol-co-secreting adenomas: endocrine, histological and genetic findings in a subtype of primary aldosteronism
Hypertension Research (2010)
-
Combined Conn's Syndrome and Subclinical Hypercortisolism From an Adrenal Adenoma Associated With Homolateral Renal Carcinoma
American Journal of Hypertension (2008)