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Asla Q, Sardà H, Lerma E, Hanzu FA, Rodrigo MT, Urgell E, Pérez JI, Webb SM, Aulinas A. 11-Deoxycorticosterone Producing Adrenal Hyperplasia as a Very Unusual Cause of Endocrine Hypertension: Case Report and Systematic Review of the Literature. Front Endocrinol (Lausanne) 2022; 13:846865. [PMID: 35432204 PMCID: PMC9008131 DOI: 10.3389/fendo.2022.846865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Queralt Asla
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Helena Sardà
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Enrique Lerma
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Pathological Anatomy, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Felicia A. Hanzu
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - María Teresa Rodrigo
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Pathological Anatomy, Hospital Clínic, Barcelona, Spain
| | - Eulàlia Urgell
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Ignacio Pérez
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Susan M. Webb
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit 747), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Aulinas
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit 747), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Anna Aulinas,
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Nally LM, Conner E, Paige S, Mooney KL, Naber U, Richards R, Wright G. Multi-disciplinary evaluation of a 5-month-old with hypertrophic cardiomyopathy related to a functional adrenocortical tumor. J Pediatr Endocrinol Metab 2018; 31:1371-1376. [PMID: 30352041 DOI: 10.1515/jpem-2018-0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) in childhood is a rare diagnosis, and associations with adrenocortical tumors (ACTs) have been rarely reported in the pediatric literature. Case presentation We present a case of a 5-month-old who presented with HCM and during the evaluation for hypertension was found to have elevated glucocorticoids, mineralocorticoids, androgens and urine metanephrines. During preoperative evaluation, he developed shock followed by cardiogenic collapse requiring extracorporeal membrane oxygenation (ECMO); however, he did not survive. Pathology revealed an ACT with hormone production that contributed to his demise. Conclusions Adrenocortical tumors associated with hypertrophic cardiomyopathy can be life-threatening. We discuss the complex interplay of unrestricted cortical hormone production in the setting of hypertrophic cardiomyopathy that may lead to rapid decline and poor clinical outcomes.
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Affiliation(s)
- Laura M Nally
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, 300 Pasteur Drive G-313, Stanford, CA 94304, USA
| | - Erin Conner
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Sharon Paige
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Kelly L Mooney
- Department of Pathology, Stanford Health Care, Stanford University, Stanford, CA, USA
| | - Urs Naber
- Department of Critical Care, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Rebecca Richards
- Department of Pediatrics, Division of Hematology and Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Gail Wright
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
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Podetta M, Pusztaszeri M, Toso C, Procopiou M, Triponez F, Sadowski SM. Oncocytic Adrenocortical Neoplasm with Concomitant Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2017; 8:384. [PMID: 29403439 PMCID: PMC5786566 DOI: 10.3389/fendo.2017.00384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022] Open
Abstract
Adrenal oncocytoma (AO) is an extremely rare adrenocortical neoplasm and little is known about its malignant potential, secretory properties, and hereditary origin. We present the case of a benign AO with concomitant incidentally found papillary thyroid cancer (PTC) and review similar cases in the literature. Immunohistochemistry and next-generation sequencing (NGS) were performed. A 66-year-old women was incidentally found to have a large, androgen-secreting right adrenal mass. 18F-Fluorodeoxyglucose positron emission tomography showed intense uptake (SUVmax 88.7) of this mass and found a hypermetabolic right thyroid mass. Open adrenalectomy was performed for this highly suspicious adrenal mass. Histopathology revealed benign AO that was BRAFV600E negative, with low Ki-67, and no somatic mutation found on NGS. Thyroidectomy revealed invasive, BRAFV600E-positive PTC. At 6 months follow-up, androgen levels returned to normal, and no recurrence was seen on imaging. To our knowledge, this is the first report of an androgen-secreting AO with concomitant PTC. Possibly the simultaneous discovery of two independent neoplasms was observed. In conclusion, this case highlights that care should be given to exclude concomitant neoplasms. Long-term and regular imaging with biochemical follow-up is warranted, since the outcome and clinical behavior of AO remains uncertain.
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Affiliation(s)
- Michele Podetta
- Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Marc Pusztaszeri
- Department of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Samira Mercedes Sadowski
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
- *Correspondence: Samira Mercedes Sadowski,
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Mitchell J, Barbosa G, Tsinberg M, Milas M, Siperstein A, Berber E. Unrecognized adrenal insufficiency in patients undergoing laparoscopic adrenalectomy. Surg Endosc 2008; 23:248-54. [DOI: 10.1007/s00464-008-0189-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 09/24/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
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