Ewha Med J.  2015 Oct;38(3):129-132. 10.12771/emj.2015.38.3.129.

Incidentally Discovered Aldosterone and Cortisol Cosecreting Adrenal Cortical Adenoma

• Bae JY
• Lee J
• Han Y
• Min SK
• Cho MS
• Sung YA

• KMID: 2171351
• DOI: http://doi.org/10.12771/emj.2015.38.3.129

Abstract

A substantial proportion of adrenal incidentalomas demonstrates subtle hormonal hypersecretion; however, adenomas that cosecrete aldosterone and cortisol are rare. We here report a case of an adrenal mass that was incidentally detected on a computed tomography scan in a 57-year-old man. The patient had a 10-year history of diabetes mellitus and a 5-year history of hypertension. Evaluation revealed hyperaldosteronemia with an elevated plasma aldosterone-to-renin ratio, hypokalemia, unsuppressed cortisol after dexamethasone administration, and elevated urinary free cortisol concentration. The appearance of the right adrenalectomy specimen indicated adrenal adenoma. Postoperatively, the blood glucose and blood pressure control improved and the urinary cortisol and aldosterone-to-renin ratio normalized. A complete endocrine evaluation in patients with incidentally discovered adrenal masses should be performed, even if the patient has a long-standing history of hypertension and diabetes, to avoid any postoperative adrenal crises.

Keyword

Cosecreting adrenal adenoma; Adrenal incidentaloma; Primary hyperaldosteronism; Adrenal adenoma

MeSH Terms

Adenoma
Adrenalectomy
Adrenocortical Adenoma*
Aldosterone*
Blood Glucose
Blood Pressure
Dexamethasone
Diabetes Mellitus
Humans
Hydrocortisone*
Hyperaldosteronism
Hypertension
Hypokalemia
Middle Aged
Plasma
Aldosterone
Blood Glucose
Dexamethasone
Hydrocortisone

Figure

• 

  Fig. 1 Abdominal computed tomography findings. A 2.5×2.0-cm well-circumscribed and homogeneous mass with a density of 60.4 Hounsfield units is seen at the right adrenal gland (arrow).

• 

  Fig. 2 Photomicrograph of the tumor cells. Clear, vacuolated cytoplasm is admixed with abundant and eosinophilic cytoplasm, which contains spironolactone bodies (arrow; H&E, ×400).

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