Endocrine Abstracts

Introduction: Connshing syndrome is a rare disease characterized by mixed overproduction of mineralocorticoids and glucocorticoids from adrenal adenoma. We will describe a clinical case that illustrates a rare combination of aldosterone-cortisol co-secreting formation of the left adrenal gland against a background of bilateral macronodular adrenal hyperplasia, and the role of diagnostic methods in determining appropriate tactics for patient treatment.

Case Description: In January 2022, 49-year-old male was admitted to the Endocrinology Research Centre with complaints of increased blood pressure of 220/110 mm Hg, despite multicomponent antihypertensive therapy. According to the hormonal profile, primary hyperaldosteronism was confirmed (aldosterone 2770 pmol/l was increased, renin 0.5 mU/l, and hypokalemia was 2.71 mmol/l against a background of discontinuation of drugs that affect the renin-angiotensin system). ACTH-independent hypercortisolism was confirmed (cortisol in saliva in the evening was 60.33 nmol/l, dexamethasone suppression test was negative (cortisol was 238.8 nmol/l in the morning), ACTH in the morning was 4.88 pg/ml). Once spironolactone (250 mg per day) was introduced in addition to moxonidine (0.6 mg per day), nifedipine (90 mg per day), doxazosin (6 mg per day), the patient’s blood pressure and potassium was stabilized. As a result of MSCT of the abdominal cavity, the formation 30×35×41 mm in the left adrenal gland and the formation is 32×18×17 mm in the right adrenal gland were observed. The density was 17 HU in the native phase in the left adrenal gland, the absolute washout coefficient was 93%, the density was 9 HU in the native phase in the right adrenal gland, the absolute washout coefficient was 72%. To lateralize the side of aldosterone hyperproduction, adrenal vein sampling was performed. Unilateral hyperproduction of aldosterone on the left was confirmed (selectivity coefficient on the left was 27.5, on the right was 4.2 (both more than 3.0). The lateralizing gradient on the left was 2.8 (more than 2.0). Taking into account hypercortisolemia, a calculation was carried out on plasma normetanephrine levels. Laparoscopic left-sided adrenalectomy was performed in August of 2022. After surgical treatment, spironolactone was discontinued, but the patient was forced to take multicomponent antihypertensive therapy due to nephropathy (C3bA3) and a long history of arterial hypertension due to untimely treatment.

Conclusion: Primary hyperaldosteronism is associated with increased cardiovascular risk, and hypercortisolism increases the risk of developing diabetes mellitus and osteoporosis. This case demonstrates the consequences of a late diagnosis of the mixed overproduction of mineralocorticoids and glucocorticoids caused by adrenal adenoma.