Endocrinol Metab.  2015 Dec;30(4):607-613. 10.3803/EnM.2015.30.4.607.

Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently

Affiliations
  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jaehyeon@skku.edu
  • 3Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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.

Keyword

Adrenocortical adenoma; Hyperaldosteronism; Cushing syndrome

MeSH Terms

Adenoma
Adrenalectomy
Adrenocortical Adenoma
Adult
Aldosterone*
Blood Pressure
Cushing Syndrome
Dexamethasone
Diagnosis
Female
Humans
Hydrocortisone*
Hyperaldosteronism
Hypertension
Hypokalemia
Korea
Plasma
Veins
Aldosterone
Dexamethasone
Hydrocortisone

Figure

  • Fig. 1 Adrenal Images. (A, B) Adrenal computed tomography. Axial images showed bilateral adrenal masses (arrows), including a 1.6-cm mass on the right adrenal gland (A) and a 2-cm mass on the left (B). (C) Adrenal NP-59 scan demonstrated focally increased radioactive uptakes in the bilateral adrenal gland areas (arrow, arrowhead), especially on the left side (arrowhead).

  • Fig. 2 Adrenalectomy specimens (gross and microscopic findings). (A) The right adrenal mass was a 1.4×1.4×1.2-cm ovoid, bright yellow, and well-circumscribed mass arising from the cortex. (B) Microscopically, the right adrenal mass consisted primarily of clear cells (H&E stain, ×200). (C) The left adrenal mass was brown, solid in appearance, and encapsulated. (D) The left adrenal mass was composed of both clear cells and eosinophilic compact cells (H&E stain, ×200).


Cited by  1 articles

Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Mitsuhide Naruse, Akiyo Tanabe, Koichi Yamamoto, Hiromi Rakugi, Mitsuhiro Kometani, Takashi Yoneda, Hiroki Kobayashi, Masanori Abe, Youichi Ohno, Nobuya Inagaki, Shoichiro Izawa, Masakatsu Sone
Endocrinol Metab. 2021;36(5):965-973.    doi: 10.3803/EnM.2021.1192.


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