Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia
BackgroundCoexisting primary aldosteronism (PA) and subclinical Cushing's syndrome (SCS) caused by bilateral adrenocortical adenomas have occasionally been reported. Precise diagnosis and treatment of the disease pose a challenge to clinicians due to its atypical clinical manifestations and lab...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-05-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.911333/full |
| _version_ | 1798045552257007616 |
|---|---|
| author | Lihua Hu Wenjun Ji Meiyu Guo Tieci Yi Jie Wang Minghui Bao Yusi Gao Han Jin Difei Lu Wei Ma Xiaoning Han Jianping Li Zhenfang Yuan |
| author_facet | Lihua Hu Wenjun Ji Meiyu Guo Tieci Yi Jie Wang Minghui Bao Yusi Gao Han Jin Difei Lu Wei Ma Xiaoning Han Jianping Li Zhenfang Yuan |
| author_sort | Lihua Hu |
| collection | DOAJ |
| description | BackgroundCoexisting primary aldosteronism (PA) and subclinical Cushing's syndrome (SCS) caused by bilateral adrenocortical adenomas have occasionally been reported. Precise diagnosis and treatment of the disease pose a challenge to clinicians due to its atypical clinical manifestations and laboratory findings.Case SummaryA 49-year-old woman was admitted to our hospital due to fatigue, increased nocturia and refractory hypertension. The patient had a history of severe left hydronephrosis 6 months prior. Laboratory examinations showed hypokalaemia (2.58 mmol/L) and high urine potassium (71 mmol/24 h). Adrenal computed tomography (CT) showed bilateral adrenal masses. Undetectable ACTH and unsuppressed plasma cortisol levels by dexamethasone indicated ACTH-independent Cushing's syndrome. Although the upright aldosterone-to-renin ratio (ARR) was 3.06 which did not exceed 3.7, elevated plasma aldosterone concentrations (PAC) with unsuppressed PAC after the captopril test still suggested PA. Adrenal venous sampling (AVS) without adrenocorticotropic hormone further revealed hypersecretion of aldosterone from the right side and no dominant side of cortisol secretion. A laparoscopic right adrenal tumor resection was performed. The pathological diagnosis was adrenocortical adenoma. After the operation, the supine and standing PAC were normalized; while the plasma cortisol levels postoperatively were still high and plasma renin was activated. The patient's postoperative serum potassium and 24-h urine potassium returned to normal without any pharmacological treatment. In addition, the patient's blood pressure was controlled normally with irbesartan alone.ConclusionPatients with refractory hypertension should be screened for the cause of secondary hypertension. AVS should be performed in patients in which PA is highly suspected to determine whether there is the option of surgical treatment. Moreover, patients with PA should be screened for hypercortisolism, which can contribute to a proper understanding of the AVS result. |
| first_indexed | 2024-04-11T23:23:55Z |
| format | Article |
| id | doaj.art-0682ad2e04734d86a6d663358d361eef |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T23:23:55Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-0682ad2e04734d86a6d663358d361eef2022-12-22T03:57:23ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-05-01910.3389/fcvm.2022.911333911333Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus HypokalaemiaLihua Hu0Wenjun Ji1Meiyu Guo2Tieci Yi3Jie Wang4Minghui Bao5Yusi Gao6Han Jin7Difei Lu8Wei Ma9Xiaoning Han10Jianping Li11Zhenfang Yuan12Department of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Hematology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Endocrinology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Cardiology, Peking University First Hospital, Beijing, ChinaDepartment of Endocrinology, Peking University First Hospital, Beijing, ChinaBackgroundCoexisting primary aldosteronism (PA) and subclinical Cushing's syndrome (SCS) caused by bilateral adrenocortical adenomas have occasionally been reported. Precise diagnosis and treatment of the disease pose a challenge to clinicians due to its atypical clinical manifestations and laboratory findings.Case SummaryA 49-year-old woman was admitted to our hospital due to fatigue, increased nocturia and refractory hypertension. The patient had a history of severe left hydronephrosis 6 months prior. Laboratory examinations showed hypokalaemia (2.58 mmol/L) and high urine potassium (71 mmol/24 h). Adrenal computed tomography (CT) showed bilateral adrenal masses. Undetectable ACTH and unsuppressed plasma cortisol levels by dexamethasone indicated ACTH-independent Cushing's syndrome. Although the upright aldosterone-to-renin ratio (ARR) was 3.06 which did not exceed 3.7, elevated plasma aldosterone concentrations (PAC) with unsuppressed PAC after the captopril test still suggested PA. Adrenal venous sampling (AVS) without adrenocorticotropic hormone further revealed hypersecretion of aldosterone from the right side and no dominant side of cortisol secretion. A laparoscopic right adrenal tumor resection was performed. The pathological diagnosis was adrenocortical adenoma. After the operation, the supine and standing PAC were normalized; while the plasma cortisol levels postoperatively were still high and plasma renin was activated. The patient's postoperative serum potassium and 24-h urine potassium returned to normal without any pharmacological treatment. In addition, the patient's blood pressure was controlled normally with irbesartan alone.ConclusionPatients with refractory hypertension should be screened for the cause of secondary hypertension. AVS should be performed in patients in which PA is highly suspected to determine whether there is the option of surgical treatment. Moreover, patients with PA should be screened for hypercortisolism, which can contribute to a proper understanding of the AVS result.https://www.frontiersin.org/articles/10.3389/fcvm.2022.911333/fullhypertensionprimary aldosteronismsubclinical cushing's syndromeadrenal venous samplingcase report |
| spellingShingle | Lihua Hu Wenjun Ji Meiyu Guo Tieci Yi Jie Wang Minghui Bao Yusi Gao Han Jin Difei Lu Wei Ma Xiaoning Han Jianping Li Zhenfang Yuan Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia Frontiers in Cardiovascular Medicine hypertension primary aldosteronism subclinical cushing's syndrome adrenal venous sampling case report |
| title | Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia |
| title_full | Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia |
| title_fullStr | Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia |
| title_full_unstemmed | Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia |
| title_short | Case Report: Primary Aldosteronism and Subclinical Cushing Syndrome in a 49-Year-Old Woman With Hypertension Plus Hypokalaemia |
| title_sort | case report primary aldosteronism and subclinical cushing syndrome in a 49 year old woman with hypertension plus hypokalaemia |
| topic | hypertension primary aldosteronism subclinical cushing's syndrome adrenal venous sampling case report |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.911333/full |
| work_keys_str_mv | AT lihuahu casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT wenjunji casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT meiyuguo casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT tieciyi casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT jiewang casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT minghuibao casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT yusigao casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT hanjin casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT difeilu casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT weima casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT xiaoninghan casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT jianpingli casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia AT zhenfangyuan casereportprimaryaldosteronismandsubclinicalcushingsyndromeina49yearoldwomanwithhypertensionplushypokalaemia |