Endocrine Abstracts

Background: Cases of combined primary aldosteronism and preclinical Cushing’s syndrome are reported extremely rare.

Highlight of a report: An unusual case of hyperaldosteronism due to bilateral macronodular adenomas with a left renal mass in a 55-year-old male is presented. MRI scan of the abdomen revealed a 4.5 cm mass of the right adrenal and two nodules in the left adrenal sized 2 and 3 cm, respectively in diameter. Additionally, a large mass on the left kidney sized 10×12 cm was also detected. Increased plasma aldosterone, decreased serum potassium and low plasma renin activity were consistent with aldosterone-producing adenoma. Although cortisol urine levels were marginally elevated, serum cortisol diurnal variation was normal, with suppression of cortisol after 1 mg of dexamethasone. Adrenal scintigraphy with ¹³¹I-6-β-iodomethyl-norcholesterol, after 2 days administration of cortisol, showed an uptake of the right adrenal mass with inhibition of the contralateral adrenal gland. Kidney scintigraphy with 99MTC-DTPA showed a normal radioactive distribution with the left renal mass appearing photopenic.

Histopathology of the nodules showed clear cells admixed with paradoxical hyperplasia of zona glomerulosa and fasciculata. The left renal mass primarily composed of collagenized hyalinized fibrous tissue with many inflammatory cells surrounding necrotizing tissue with hemorrhage and cholesterol crystals. After adrenalectomy the patient’s blood pressure was normalized.

Conclusion: This is the first case in the literature of bilateral involvement of the adrenals causing hyperaldosteronism with a concurrent renal mass.