ECE2020 ePoster Presentations Adrenal and Cardiovascular Endocrinology (58 abstracts)
Bilateral adrenal adenomas and primary hyperaldosteronism – case report
Madalina Chiriac (Bozac) 1 , Tomaz Kocjan 2 , Nicolae Crisan 3 , Ana Valea 4 , Ioana Ilie 5 , Cristina A Silaghi 5 , Tudor Gliga 6 & Carmen Georgescu 5
1Iuliu Hatieganu“ University of Medicine and Pharmacy Cluj-Napoca, Romania, Endocrinology, Cluj-Napoca, Romania; 2Ljubljana University Medical Centre, Endocrinology, Diabetes and Metabolic Diseases, Ljubljana , Slovenia; 3Urology Department of Clinical Municipal Hospital Cluj-Napoca, Iuliu Hatieganu “University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania; 4Endocrinology Department of Clinical County Emergency Hospital Cluj-Napoca, Iuliu Hatieganu “University of Medicine and Pharmacy Cluj-Napoca, Romania, Romania; 5Endocrinology Department of Clinical County Emergency Hospital Cluj-Napoca, Iuliu Hatieganu “University of Medicine and Pharmacy Cluj-Napoca, Romania, Cluj-Napoca, Romania; 6Endocrinology, Clinical County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
Introduction: Primary aldosteronism (PA) is an important cause of secondary hypertension, associated with increased cardiovascular morbidity and mortality rate compared to patients with essential hypertension.
Case report: We report the case of a 59-year-old Caucasian male with a medical history of dilatative cardiomiopathy, paroxysmal atrial fibrillation and bifascicular block who was admitted to the E.R. with shortness of breath, headache, palpitations, blood pressure at 162/117 mmHg and concomitant hypokalemia (2.5 mmol/l). The patient had no clinical signs of cortisol excess. Laboratory tests showed the following: elevated plasma aldosterone at 41.2 ng/dl, supressed renin activity (<0.10 ng AI/ml/h), elevated aldosterone/renine ratio at 420, urinary metanephrines at 141 µg/24 h, 8 h cortisol at 18.5 µg/dl and no supression of cortisol levels by low-dose dexamethasone in addition to low-normal ACTH levels (11 pg/ml). The abdominal MRI scan showed nodules in both adrenal glands (in the right medial of 23/18 mm, right lateral of 12/9 mm, left central of 13/14 mm and left lateral of 7/9 mm). Adrenal venous sampling further evidenced aldosterone secretion from the right adrenal gland (aldosterone/cortisol ratio – right/left was 3.89, 3.65 and 8.17:1). Unilateral right adrenalectomy was performed and the histopatological examination concluded the presence of right adrenal adenomas. The clinical outcome was favorable, with regression of blood pressure values and development of short-term secondary hyperkalemia.
Conclusion: Distinction between unilateral and bilateral secreting adenoma is an important stage and in such cases adrenal venous sampling is essential in diagnosis and establishing case management. In rare instances, cosecretion of aldosterone and cortisol has been reported.
Keywords: hyperaldosteronism, adrenal venous sampling, cortisol
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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