Endocrine Abstracts

Background: Endocrine pathologies are a common cause of secondary hypertension. Most patients with primary aldosteronism and primary hyperparathyroidism suffer from hypertension. Although the coexistence of parathyroid adenoma and cones syndrome in the same patient is uncommon, the occurrence of these two adenomas at the same time can have significant implications for the patient’s clinical presentation, diagnostic evaluation, and treatment approach.

Case Presentation: A 64-year-old Caucasian female was referred by her cardiologist to our clinic due to uncontrolled hypertension for 10-11 years, dyslipidemia and hypokalemia, case-typified resistant hypertension-related target organ damage symptoms, and a history of cardiovascular events. The patient’s medical history is remarkable for lithotripsy due to nephrolithiasis in 2017-2018; In 2019 a coronary bypass was performed. History revealed that she was prescribed ace inhibitor in combination with thiazide diuretic and beta blocker for hypertension, atorvastatin for dyslipidemia. In her family history, none of her first-degree relatives had malignancy, her mother died at 50 years of age due to thromboembolism. On her P/E: BP 140/90 mm/hg pulse 90. The laboratory examinations reported: CBC, Urea, Creatinine, OH-vit-D3, cortisol catecholamine and its metabolites in 24 h urine, sodium, thyroid function tests, ACTH, PRL were normal, Potassium 2.0 mmol/l -L, ionized Calcium 1.7 mmol/l -H, Phosphorus: 0.7 mmol/l -L aldosterone level was measured after normalization of potassium level aldosterone 251,11 pg/ml-H, renin 5.91 pg/ml-L/N renin-Aldosterone ratio 40.34-H, Abdominal MRI revealed 1.6 -2.0 cm right adrenal adenoma. Thyroid ultrasound revealed a 22/14/12 mm hypoechogenic nodule at the lower part of the left lobe and a 16/9/7 mm iso echogenic nodular lesion at the lower posterior part of the right lobe. After biochemical confirmation of hyperparathyroidism technetium -99m sestamibi scintigraphy SPECT- CT confirmed the diagnosis of parathyroid adenoma, the mass was adjoined the lower pole of the left lobe of the thyroid gland. Followed by biopsy malignancy was excluded. Subsequent examinations, including densitometry identified osteoporosis. Based on these findings, a diagnosis of primary hyperparathyroidism associated with aldosterone-secreting adenoma was made. The patient was provided 50 mg of spironolactone daily, BP and potassium were normalized and the patient was operated for parathyroid adenoma. PTH, Ca, and phosphorus normalized after surgery. Blood pressure is controlled with spironolactone, osteoporosis is treated with denosumab, and in 2-3 months adrenalectomy is planned

Conclusion: In this unique case report, we present the clinical details, diagnostic evaluation, and management approach of a rare case involving the coexistence of an adrenal adenoma and a parathyroid adenoma.