Primary aldosteronism caused by a unilateral adrenal adenoma accompanied by autonomous cortisol secretion

Jiro Suzuki, Fumio Otsuka, Kenichi Inagaki, Hiroyuki Otani, Tomoko Miyoshi, Tomohiro Terasaka, Toshio Ogura, Masako Omori, Yasutomo Nasu, Hirofumi Makino

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

A 35-year-old Japanese woman was referred for further examination of persistent hypertension with hypokalemia. Her serum aldosterone levels were high and her plasma renin activity markedly suppressed. Radiological examinations revealed the presence of a 3-cm diameter left adrenal tumor. 131I-adosterol was specifically accumulated in the left adrenal tumor, whereas the accumulation in the right adrenal was completely suppressed. Low-dose dexamethasone failed to suppress cortisol secretion although the serum cortisol levels were within the normal range. Urinary excretion of 17-hydroxycorticosteroids but not 17-ketosteroids was increased. Levels of plasma adrenocorticotropin (ACTH) and serum dehydroepiandrosterone sulfate (DHEAS) were decreased. Upon diagnosis of left aldosteronoma with autonomous secretion of cortisol, left adrenalectomy was performed by laparoscopy. In the resected adenoma tissues, clear cells expressed P450c17 protein and the ratio of CYP17/CYP11B2 mRNA evaluated by quantitative real-time polymerase chain reaction (PCR) was apparently higher than that of typical aldosteronomas. Based on the corticotropin-releasing hormone (CRH) loading tests, the contra-lateral adrenal functions were restored 3 months after surgery. These results indicate that evaluation for autonomy of cortisol secretion and contralateral adrenal function is clinically important to avoid the risk of adrenal failure after surgery for primary aldosteronism.

Original languageEnglish
Pages (from-to)367-373
Number of pages7
JournalHypertension Research
Volume30
Issue number4
DOIs
Publication statusPublished - Apr 2007

Keywords

  • CYP11B2
  • CYP17
  • P450C17
  • Preclinical cushing's syndrome
  • Primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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