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Zhao L, Wan J, Wang Y, Yang W, Liang Q, Wang J, Jin P. Different cell compositions and a novel somatic KCNJ5 variant found in a patient with bilateral adrenocortical adenomas secreting aldosterone and cortisol. Front Endocrinol (Lausanne) 2023; 14:1068335. [PMID: 36960396 PMCID: PMC10028271 DOI: 10.3389/fendo.2023.1068335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION This study aimed to explore the possible pathogenesis of a rare case of co-existing Cushing's syndrome (CS) and primary aldosteronism (PA) caused by bilateral adrenocortical adenomas secreting aldosterone and cortisol, respectively. METHODS A 41-year-old Chinese woman with severe hypertension and hypokalemia for 5 and 2 years, respectively, was referred to our hospital. She had a Cushingoid appearance. Preoperative endocrinological examinations revealed autonomous cortisol and aldosterone secretion. Computed tomography revealed bilateral adrenal adenomas. Subsequently, adrenal vein sampling and sequential left and right partial adrenalectomy indicated the presence of a left aldosterone-producing tumor and a right cortisol-producing tumor. Pathological examination included immunohistochemical analysis of the resected specimens. Secretions of aldosterone and cortisol were observed both in vivo and in vitro. Further, whole-exome sequencing was performed for DNA that was extracted from peripheral blood leukocytes and bilateral adrenal adenomas in order to determine whether the patient had relevant variants associated with PA and CS. RESULTS Immunohistochemical staining revealed that the left adenoma primarily comprised clear cells expressing CYP11B2, whereas the right adenoma comprised both eosinophilic compact and clear cells expressing CYP11B1. The mRNA levels of steroidogenic enzymes (including CYP11B1 and CYP17A1) were high in the right adenoma, whereas CYP11B2 was highly expressed in the left adenoma. A novel somatic heterozygous missense variant-KCNJ5 c.503T > G (p.L168R)-was detected in the left adrenal adenoma, but no other causative variants associated with PA and CS were detected in the peripheral blood or right adrenocortical adenoma. In the primary cell culture of the resected hyperplastic adrenal adenomas, verapamil and nifedipine, which are two calcium channel blockers, markedly inhibited the secretion of both aldosterone and cortisol. CONCLUSION We present an extremely rare case of bilateral adrenocortical adenomas with distinct secretion of aldosterone and cortisol. The heterogeneity of the tumor cell compositions of aldosterone- and cortisol-producing adenoma (A/CPA) and somatic mutation of KCNJ5 may have led to different hormone secretions in the bilateral adrenal adenomas.
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Affiliation(s)
- Liling Zhao
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinjing Wan
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yujun Wang
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenjun Yang
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinrong Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ping Jin
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Ping Jin,
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Heinrich DA, Quinkler M, Adolf C, Handgriff L, Müller L, Schneider H, Sturm L, Künzel H, Seidensticker M, Deniz S, Ladurner R, Beuschlein F, Reincke M. Influence of cortisol cosecretion on non-ACTH-stimulated adrenal venous sampling in primary aldosteronism: a retrospective cohort study. Eur J Endocrinol 2022; 187:637-650. [PMID: 36070424 DOI: 10.1530/eje-21-0541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cortisol measurements are essential for the interpretation of adrenal venous samplings (AVS) in primary aldosteronism (PA). Cortisol cosecretion may influence AVS indices. We aimed to investigate whether cortisol cosecretion affects non-adrenocorticotrophic hormone (ACTH)-stimulated AVS results. DESIGN Retrospective cohort study at a tertiary referral center. METHODS We analyzed 278 PA patients who underwent non-ACTH-stimulated AVS and had undergone at least a 1-mg dexamethasone suppression test (DST). Subsets underwent additional late-night salivary cortisol (LSC) and/or 24-h urinary free cortisol (UFC) measurements. Patients were studied from 2013 to 2020 with follow-up data of 6 months following adrenalectomy or mineralocorticoid antagonist therapy initiation. We analyzed AVS parameters including adrenal vein aldosterone/cortisol ratios, selectivity, lateralization (LI) and contralateral suppression indices and post-operative ACTH-stimulation. We classified outcomes according to the primary aldosteronism surgical outcome (PASO) criteria. RESULTS Among the patients, 18.9% had a pathological DST result (1.9-5 µg/dL: n = 44 (15.8%); >5 µg/dL: n = 8 (2.9%)). Comparison of AVS results stratified according to the 1-mg DST (≤1.8 vs >1.8 µg/dL: P = 0.499; ≤1.8 vs 1.8 ≤ 5 vs >5 µg/dL: P = 0.811) showed no difference. Lateralized cases with post DST serum cortisol values > 5 µg/dL had lower LI (≤1.8 µg/dL: 11.11 (5.36; 26.76) vs 1.9-5 µg/dL: 11.76 (4.9; 31.88) vs >5 µg/dL: 2.58 (1.67; 3.3); P = 0.008). PASO outcome was not different according to cortisol cosecretion. CONCLUSIONS Marked cortisol cosecretion has the potential to influence non-ACTH-stimulated AVS results. While this could result in falsely classified lateralized cases as bilateral, further analysis of substitutes for cortisol are required to unmask effects on clinical outcome.
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Affiliation(s)
| | | | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Laura Handgriff
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Lisa Müller
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Holger Schneider
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Lisa Sturm
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Heike Künzel
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Munich, Germany
| | - Sinan Deniz
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Munich, Germany
| | - Roland Ladurner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, LMU Klinikum, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich (USZ) and Universität Zürich (UZH), Zurich, Switzerland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany
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Uduagbamen PK, Kadiri S. Intradialysis hypotension and hypertension in patients with end stage kidney disease in Nigeria: risk factors and clinical correlates. Ghana Med J 2021; 55:34-42. [PMID: 38322382 PMCID: PMC10665260 DOI: 10.4314/gmj.v55i1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background Many shortcomings associated with haemodialysis for instance, intradialysis blood pressure changes, often lead to inadequate dialysis dose. Measures are needed to improve on this. Objectives To determine the risk factors and clinical correlates of intradialysis blood pressure variations. Methods Maintenance haemodialysis sessions for 232 consented patients with end stage kidney disease who had 1248 sessions were studied. Data collected was from history, examination findings, serum electrolytes and hematocrit. Blood pressure reading was taken manually at rest. Statistical analysis was with SPSS 22. Chi square and t-test were used to compare proportions and means respectively while regression analysis was used to determine predictors of blood pressure changes. Results The mean age of participants was 49.9 ± 4.6. More participants (38.8%) had hypertension associated CKD, than chronic glomerulonephritis, (37.9%). Majority (60.7%) had internal jugular catheter. Intradialysis hypertension was commoner than intradialysis hypotension (24.4% versus 19.4%). Intradialysis hypotension was commoner in females, diabetics and with less frequent dialysis while intradialysis hypertension was commoner in males, frequent erythropoietin use. The mean dialysis dose (Kt/V) was 1.02 ± 0.4, with 0.68 ± 0.1 for intradialysis hypotension and 0.84 ± 0.2 for intradialysis hypertension. Conclusion Risk factors for intradialysis hypertension were males, frequent erythropoietin use while for intradialysis hypotension, were female gender and less frequent dialysis. Effective intra and inter-dialytic blood pressure control with adequate pre dialysis work up should be carried out to lessen the degree, burden and outcome of these variations. Funding None declared.
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Affiliation(s)
- Peter K Uduagbamen
- Division of Nephrology and Hypertension, Department of Internal Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
- Nephrology Unit, Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Solomon Kadiri
- Nephrology Unit, Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
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Ishidoya S. Editorial Comment to Adrenalectomy in Japanese patients with subclinical Cushing syndrome: 1-mg dexamethasone suppression test to predict the surgical benefit. Int J Urol 2020; 28:279. [PMID: 33350009 DOI: 10.1111/iju.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shigeto Ishidoya
- Department of Urology, Sendai City Hospital, Sendai, Miyagi, Japan
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O'Toole SM, Sze WCC, Chung TT, Akker SA, Druce MR, Waterhouse M, Pitkin S, Dawnay A, Sahdev A, Matson M, Parvanta L, Drake WM. Low-grade Cortisol Cosecretion Has Limited Impact on ACTH-stimulated AVS Parameters in Primary Aldosteronism. J Clin Endocrinol Metab 2020; 105:5891767. [PMID: 32785656 DOI: 10.1210/clinem/dgaa519] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
CONTEXT In primary aldosteronism, cosecretion of cortisol may alter cortisol-derived adrenal venous sampling indices. OBJECTIVE To identify whether cortisol cosecretion in primary aldosteronism alters adrenal venous sampling parameters and interpretation. DESIGN Retrospective case-control study. SETTING A tertiary referral center. PATIENTS 144 adult patients with primary aldosteronism who had undergone both adrenocorticotropic hormone-stimulated adrenal venous sampling and dexamethasone suppression testing between 2004 and 2018. MAIN OUTCOME MEASURES Adrenal venous sampling indices including adrenal vein aldosterone/cortisol ratios and the selectivity, lateralization, and contralateral suppression indices. RESULTS 21 (14.6%) patients had evidence of cortisol cosecretion (defined as a failure to suppress cortisol to ≤50 nmol/L post dexamethasone). Patients with evidence of cortisol cosecretion had a higher inferior vena cava cortisol concentration (P = .01) than those without. No difference was observed between the groups in terms of selectivity index, lateralization index, lateralization of aldosterone excess, or adrenal vein cannulation rate. CONCLUSIONS Cortisol cosecretion alters some parameters in adrenocorticotrophic hormone-stimulated adrenal venous sampling but does not result in alterations in patient management.
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Affiliation(s)
- Samuel Matthew O'Toole
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Teng-Teng Chung
- Department of Endocrinology, University College London Hospital, London, UK
| | - Scott Alexander Akker
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maralyn Rose Druce
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mona Waterhouse
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
| | - Sarah Pitkin
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's Hospital, London, UK
| | - Matthew Matson
- Department of Radiology, St Bartholomew's Hospital, London, UK
| | - Laila Parvanta
- Department of Endocrine Surgery, St Bartholomew's Hospital, London, UK
| | - William Martyn Drake
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ren K, Wei J, Liu Q, Zhu Y, Wu N, Tang Y, Li Q, Zhang Q, Yu Y, An Z, Chen J, Li J. Hypercortisolism and primary aldosteronism caused by bilateral adrenocortical adenomas: a case report. BMC Endocr Disord 2019; 19:63. [PMID: 31208392 PMCID: PMC6580498 DOI: 10.1186/s12902-019-0395-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Co-existing Cushing's syndrome and primary aldosteronism caused by bilateral adrenocortical adenomas, secreting cortisol and aldosterone, respectively, have rarely been reported. Precise diagnosis and management of this disorder constitute a challenge to clinicians due to its atypical clinical manifestations and laboratory findings. CASE PRESENTATION We here report a Chinese male patient with co-existing Cushing's syndrome and primary aldosteronism caused by bilateral adrenocortical adenomas, who complained of intermittent muscle weakness for over 3 years. Computed tomography scans revealed bilateral adrenal masses. Undetectable ACTH and unsuppressed cortisol levels by dexamethasone suggested ACTH-independent Cushing's syndrome. Elevated aldosterone to renin ratio and unsuppressed plasma aldosterone concentration after saline infusion test suggested primary aldosteronism. Adrenal venous sampling adjusted by plasma epinephrine revealed hypersecretion of cortisol from the left adrenal mass and of aldosterone from the right one. A sequential bilateral laparoscopic adrenalectomy was performed. The cortisol level was normalized after partial left adrenalectomy and the aldosterone level was normalized after subsequent partial right adrenalectomy. Histopathological evaluation of the resected surgical specimens, including immunohistochemical staining for steroidogenic enzymes, revealed a left cortisol-producing adenoma and a right aldosterone-producing adenoma. The patient's symptoms and laboratory findings resolved after sequential adrenalectomy without any pharmacological treatment. CONCLUSIONS Adrenal venous sampling is essential in diagnosing bilateral functional adrenocortical adenomas prior to surgery. Proper interpretation of the laboratory findings is particularly important in these patients. Immunohistochemistry may be a valuable tool to identify aldosterone/cortisol-producing lesions and to validate the clinical diagnosis.
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Affiliation(s)
- Kaiyun Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jia Wei
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qilin Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuchun Zhu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nianwei Wu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ying Tang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qianrui Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qianying Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yerong Yu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jing Chen
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China.
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7
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Satoh F, Morimoto R, Seiji K, Satani N, Ota H, Iwakura Y, Ono Y, Kudo M, Nezu M, Omata K, Tezuka Y, Kawasaki Y, Ishidoya S, Arai Y, Takase K, Nakamura Y, McNamara K, Sasano H, Ito S. Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism? Eur J Endocrinol 2015; 173:465-77. [PMID: 26194502 DOI: 10.1530/eje-14-1161] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/20/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND DESIGN Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. METHODS We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens. RESULTS S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. CONCLUSIONS Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.
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Affiliation(s)
- Fumitoshi Satoh
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Ryo Morimoto
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kazumasa Seiji
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Nozomi Satani
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Hideki Ota
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshitsugu Iwakura
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshikiyo Ono
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Masataka Kudo
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Masahiro Nezu
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kei Omata
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yuta Tezuka
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshihide Kawasaki
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Shigeto Ishidoya
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoichi Arai
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kei Takase
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yasuhiro Nakamura
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Keely McNamara
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Hironobu Sasano
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Sadayoshi Ito
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
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8
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Yoon V, Heyliger A, Maekawa T, Sasano H, Carrick K, Woodruff S, Rabaglia J, Auchus RJ, Ghayee HK. Benign adrenal adenomas secreting excess mineralocorticoids and glucocorticoids. Endocrinol Diabetes Metab Case Rep 2013; 2013:130042. [PMID: 24616772 PMCID: PMC3922398 DOI: 10.1530/edm-13-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2013] [Accepted: 09/09/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To recognize that benign adrenal adenomas can co-secrete excess aldosterone and cortisol, which can change clinical management. METHODS We reviewed the clinical and histological features of an adrenal tumor co-secreting aldosterone and cortisol in a patient. Biochemical testing as well as postoperative immunohistochemistry was carried out on tissue samples for assessing enzymes involved in steroidogenesis. RESULTS A patient presented with hypertension, hypokalemia, and symptoms related to hypercortisolism. The case demonstrated suppressed renin concentrations with an elevated aldosterone:renin ratio, abnormal dexamethasone suppression test results, and elevated midnight salivary cortisol concentrations. The patient had a right adrenal nodule with autonomous cortisol production and interval growth. Right adrenalectomy was carried out. Postoperatively, the patient tolerated the surgery, but he was placed on a short course of steroid replacement given a subnormal postoperative serum cortisol concentration. Long-term follow-up of the patient showed that his blood pressure and glucose levels had improved. Histopathology slides showed positive staining for 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase, and 21 hydroxylase. CONCLUSION In addition to the clinical manifestations and laboratory values, the presence of these enzymes in this type of tumor provides support that the tumor in this patient was able to produce mineralocorticoids and glucocorticoids. The recognition of patients with a tumor that is co-secreting aldosterone and cortisol can affect decisions to treat with glucocorticoids perioperatively to avoid adrenal crisis. LEARNING POINTS Recognition of the presence of adrenal adenomas co-secreting mineralocorticoids and glucocorticoids.Consideration for perioperative and postoperative glucocorticoid use in the treatment of co-secreting adrenal adenomas.
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Affiliation(s)
- Vivienne Yoon
- Department of Internal Medicine/Division of Endocrinology and Metabolism VA North Texas Health Care System and the University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard, Dallas, Texas, 75390-8857 USA
| | - Aliya Heyliger
- Department of Internal Medicine/Division of Endocrinology and Metabolism VA North Texas Health Care System and the University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard, Dallas, Texas, 75390-8857 USA
| | - Takashi Maekawa
- Department of Pathology Tohoku University School of Medicine and Hospital at Sendai Sendai Japan
| | - Hironobu Sasano
- Department of Pathology Tohoku University School of Medicine and Hospital at Sendai Sendai Japan
| | - Kelley Carrick
- Department of Pathology University of Texas Southwestern Medical Center Dallas, Texas USA
| | - Stacey Woodruff
- Department of Surgery University of Texas Southwestern Medical Center Dallas, Texas USA
| | - Jennifer Rabaglia
- Department of Surgery University of Texas Southwestern Medical Center Dallas, Texas USA
| | - Richard J Auchus
- Department of Internal Medicine/Division of Metabolism Endocrinology and Diabetes University of Michigan Health System Ann Arbor, Michigan USA
| | - Hans K Ghayee
- Department of Internal Medicine/Division of Endocrinology and Metabolism VA North Texas Health Care System and the University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard, Dallas, Texas, 75390-8857 USA
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9
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Kukidome D, Miyamura N, Sakakida K, Shimoda S, Shigematu Y, Nishi K, Yamashita Y, Eto M, Sasano H, Araki E. A case of cortisol producing adrenal adenoma associated with a latent aldosteronoma: usefulness of the ACTH loading test for the detection of covert aldosteronism in overt Cushing syndrome. Intern Med 2012; 51:395-400. [PMID: 22333376 DOI: 10.2169/internalmedicine.51.5597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 36-year-old woman with Cushing syndrome was evaluated for coexisting hyperaldosteronism, which was suggested by an abnormal response of the aldosterone-to-cortisol ratio in peripheral blood to the ACTH-administration despite a low basal aldosterone-to-renin ratio. Computed tomography revealed two independent tumors in the left adrenal gland, and adrenal venous sampling indicated hyperaldosteronism in addition to hypercortisolism in the same side. Postsurgical study including immunohistochemical analysis of steroidogenic enzymes suggested one adenoma to be cortisol-producing and the other, aldosterone-producing. The comorbidity of these different hormone-producing adenomas is not rare and careful pre-surgical evaluation is necessary to avoid post-surgical exacerbation of latent hyperaldosteronism.
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Affiliation(s)
- Daisuke Kukidome
- Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan
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10
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Karashima S, Takeda Y, Cheng Y, Yoneda T, Demura M, Kometani M, Ohe M, Mori S, Yagi K, Yamagishi M. Clinical characteristics of primary hyperaldosteronism due to adrenal microadenoma. Steroids 2011; 76:1363-6. [PMID: 21801737 DOI: 10.1016/j.steroids.2011.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 11/20/2022]
Abstract
An increasing number of patients are being diagnosed with primary aldosteronism (PA) due to aldosterone-producing macroadenoma (APA). However, there are only limited data available on the clinical characteristics of PA that are associated with adrenal microadenoma. Of the 55 patients that were diagnosed with PA in our study, 22 patients showed a unilateral adrenal over-production of aldosterone. The histopathology of the surgically removed adrenal tissues led to six patients being diagnosed with microadenoma, and the clinical features of microadenoma, macroadenoma and idiopathic hyperaldosteronism (IHA) were studied. The expression levels of CYP11B2, CYP17, CYP21 and 3β-hydroxysteroid dehydrogenase 2 (HSD3B2) mRNA in the adrenal cortices (n=5 and 6, respectively) that remained attached to the adrenal microadenomas or macroadenomas were examined by real time-PCR and then compared to the expression levels in the adrenal cortices (n=5) of non-functioning adrenal adenomas (NF). The patients with microadenoma (n=6) had significantly higher diastolic blood pressure than the patients with macroadenoma (n=16) or IHA (n=33) (p<0.05). The systolic blood pressure, plasma aldosterone concentration, serum potassium level and renal function did not differ between the PA sub-groups. The levels of CYP11B2 and CYP17 mRNA were significantly increased in the adjacent tissues of microadenomas, as compared with macroadenomas or NF (p<0.05), whereas no significant differences in the CYP21 and HSD3B2 mRNA levels were found between the PA sub-groups. The tumor size did not influence the clinical characteristics of APA. The non-tumor portions of the microadenomas showed marked and sustained CYP11B2 mRNA expression under the suppressed renin-angiotensin system. We suggest that an increased number of microadenomas should be sampled, and the immunohistochemistry for steoridogenic enzymes should be investigated to clarify the etiology of microadenoma.
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Affiliation(s)
- Shigehiro Karashima
- Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
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11
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Kawasaki Y, Ishidoya S, Kaiho Y, Ito A, Satoh F, Morimoto R, Nakagawa H, Arai Y. Laparoscopic simultaneous bilateral adrenalectomy: Assessment of feasibility and potential indications. Int J Urol 2011; 18:762-7. [DOI: 10.1111/j.1442-2042.2011.02846.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Ishidoya S, Kaiho Y, Ito A, Morimoto R, Satoh F, Ito S, Ishibashi T, Nakamura Y, Sasano H, Arai Y. Single-center Outcome of Laparoscopic Unilateral Adrenalectomy for Patients With Primary Aldosteronism: Lateralizing Disease Using Results of Adrenal Venous Sampling. Urology 2011; 78:68-73. [DOI: 10.1016/j.urology.2010.12.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/19/2010] [Accepted: 12/25/2010] [Indexed: 11/25/2022]
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