Steroid profile in a case of adrenal carcinoma with severe hypertension

11-Deoxycorticosterone Producing Adrenal Hyperplasia as a Very Unusual Cause of Endocrine Hypertension: Case Report and Systematic Review of the Literature

BACKGROUND AND OBJECTIVES

11-deoxycorticosterone overproduction due to an adrenal tumor or hyperplasia is a very rare cause of mineralocorticoid-induced hypertension. The objective is to provide the most relevant clinical features that clinicians dealing with patients presenting with the hallmarks of hypertension due to 11-deoxycorticosterone-producing adrenal lesions should be aware of.

DESIGN AND METHODS

We report the case of a patient with an 11-deoxycorticosterone-producing adrenal lesion and provide a systematic review of all published cases (PubMed, Web of Science and EMBASE) between 1965 and 2021.

RESULTS

We identified 46 cases (including ours). Most cases (31, 67%) affected women with a mean age of 42.9 ± 15.2 years and presented with high blood pressure and hypokalemia (average of 2.68 ± 0.62 mmol/L). Median (interquartile range) time from onset of first suggestive symptoms to diagnosis was 24 (55) months. Aldosterone levels were low or in the reference range in 98% of the cases when available. 11-deoxycorticosterone levels were a median of 12.5 (18.9) times above the upper limit of the normal reference range reported in each article and overproduction of more than one hormone was seen in 31 (67%). Carcinoma was the most common histological type (21, 45.7%). Median tumor size was 61.5 (60) mm. Malignant lesions were larger, had higher 11-deoxycorticosterone levels and shorter time of evolution at diagnosis compared to benign lesions.

CONCLUSIONS

11-deoxycorticosterone-producing adrenal lesions are very rare, affecting mostly middle-aged women with a primary aldosteronism-like clinical presentation and carcinoma is the most frequent histological diagnosis. Measuring 11-deoxycorticosterone levels, when low aldosterone levels or in the lower limit of the reference range are present in hypertensive patients, is advisable.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework, 10.17605/OSF.IO/NR7UV.

Adrenal adenocarcinomas: histologic grading and survival

Thirty-eight patients with adrenal adenocarcinoma were reviewed. Two of 23 males and 8 of 15 females had a functioning tumor (P less than 0.005). The most striking finding in this review was the variation in survival according to histologic grade. The median survival from histologic diagnosis was for grade I tumors 54 months, for grade II tumors 26 months, for grade III tumors 1 month. The difference in survival between patients with grade I or II tumors and those with grade III tumors was significant (P less than 0.001). The majority of the patients with grade III tumors were admitted with clinical evidence of disseminated disease and died within 1 month. Among the patients with well-differentiated tumors, five who received surgical treatment of their recurrence had a median survival of 51 months, whereas seven patients who received no surgical treatment had median survival of 20 months following first recurrence (0.05 less than P less than 0.10).