Endocrine Abstracts

Primary Aldosteronism (PA) is caused by autonomous aldosterone production from the adrenal cortex (due to hyperplasia, adenoma or rarely carcinoma) and diagnosis is confirmed by elevated plasma aldosterone level with suppressed renin activity and localized further by CT scan of the adrenal glands and selective adrenal venous sampling (AVS) if required. On the other hand, Addison disease (also known as primary adrenal insufficiency) which represents the other face of the coin is a rare condition mainly due to autoimmune adrenalitis in the UK, Diagnosis is flagged by combination of hyponatraemia with hyperkalaemia, further confirmation is usually by arranging a short synacthen test (SST), ACTH level, autoantibody screening and CT/MRI of the adrenal glands. We present a case of a 79-years-old lady who has been initially diagnosed with primary hyperaldosteronism in 1999 which was confirmed clinically and biochemically at that time and commenced on spironolactone to control her symptoms and recently in June 2016 presented with features of primary adrenal insufficiency (AI) that has been confirmed biochemically as well with failed SST, elevated ACTH level and positive adrenal autoantibodies with an absolutely normal MRI of the adrenal glands. Controversial data were published about the evolution of PA after prolonged treatment with mineralocorticoid antagonist causing normalization of aldosterone levels, however occurrence of Addison’s disease in a previously confirmed hyperaldosteronism is a rare unusual condition and whether this is due to biological decline of mineralocorticoid secretion with age or due to specific drug treatment or combination of both deserve further exploration as if this is confirmed it may justify periodical diagnostic assessment of patients particularly when the clinical presentation is not severe.