Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently.
10.3803/EnM.2015.30.4.607
- Author:
Seung Eun LEE
1
;
Jae Hyeon KIM
;
You Bin LEE
;
Hyeri SEOK
;
In Seub SHIN
;
Yeong Hee EUN
;
Jung Han KIM
;
Young Lyun OH
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Adrenocortical adenoma;
Hyperaldosteronism;
Cushing syndrome
- MeSH:
Adenoma;
Adrenalectomy;
Adrenocortical Adenoma;
Adult;
Aldosterone*;
Blood Pressure;
Cushing Syndrome;
Dexamethasone;
Diagnosis;
Female;
Humans;
Hydrocortisone*;
Hyperaldosteronism;
Hypertension;
Hypokalemia;
Korea;
Plasma;
Veins
- From:Endocrinology and Metabolism
2015;30(4):607-613
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 31-year-old woman was referred to our hospital with symptoms of hypertension and bilateral adrenocortical masses with no feature of Cushing syndrome. The serum aldosterone/renin ratio was elevated and the saline loading test showed no suppression of the plasma aldosterone level, consistent with a diagnosis of primary hyperaldosteronism. Overnight and low-dose dexamethasone suppression tests showed no suppression of serum cortisol, indicating a secondary diagnosis of subclinical Cushing syndrome. Adrenal vein sampling during the low-dose dexamethasone suppression test demonstrated excess secretion of cortisol from the left adrenal mass. A partial right adrenalectomy was performed, resulting in normalization of blood pressure, hypokalemia, and high aldosterone level, implying that the right adrenal mass was the main cause of the hyperaldosteronism. A total adrenalectomy for the left adrenal mass was later performed, resulting in a normalization of cortisol level. The final diagnosis was bilateral adrenocortical adenomas, which were secreting aldosterone and cortisol independently. This case is the first report of a concurrent cortisol-producing left adrenal adenoma and an aldosterone-producing right adrenal adenoma in Korea, as demonstrated by adrenal vein sampling and sequential removal of adrenal masses.
