Endocrine Abstracts

A 56 year old female presents with the rare association of primary hyperaldosteronism with primary hyperparathyroidism and prolactinoma. The association of primary hyperaldosteronism and other endocrinopathies has only rarely been reported. There have been three case reports meeting diagnostic criteria for MEN 1 with aldosterone secreting adrenal adenomas. In all three the other endocrinopathies were pituitary adenomas and hyperparathyroidism.

The case presented in 1987 with galactorrhoea and secondary amenorrhoea. Prolactin was elevated at 1468 milliunits per litre (up to 610)and CT confirmed pituitary microadenoma. In 2000 routine biochemistry showed hypercalcaemia. Primary hyperparathyroidism was diagnosed; corrected calcium 2.95 millimoles per litre (2.25-2.6), phosphate 0.78 millimoles per litre (0.8-1.45) and PTH 262 nanograms per litre (12-72). The case had longstanding hypertension and became hypokalaemic whilst on a thiazide. Primary hyperaldosteronism was demonstrated; recumbent plasma renin activity 0.2 picomoles per litre (1.1-2.7), plasma aldosterone 910 picomoles per litre (100-450), with a poor renin response to posture. A CT of the adrenals showed a long left adrenal at 5.5cm with no discrete lesion or hypertrophy and a normal right adrenal. No pancreatic lesions were identified. In contrast to the previously described cases no focal adrenal adenoma was demonstrated.