Concurrent hypersecretion of aldosterone and cortisol from the adrenal cortical adenoma

Komiya, Ichiro; Koizumi, Yukio; Kobayashi, Ryōji; Kotani, Masanobu; Yamada, Takashi; Maruyama, Yuzo

doi:10.1016/0002-9343(79)90803-9

Cited by 36 publications

(29 citation statements)

References 2 publications

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“…[3][4][5] In these cases the association between hypercortisolism and hyperandrogenaemia could be explained by increased 17,20-lyase activity secondary to increased cyto-chrome b5 expression in the adrenal adenoma tissues, as described by Sakai et al 5 Combined cortisol and aldosterone secretion from adrenocortical adenomas has also been described. 6,7 The DHEAS values, although normal prior to surgery, decreased considerably, post-operatively, possibly indicating that DHEAS was also secreted by the adenoma.…”

Section: Discussionmentioning

confidence: 98%

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A unique case of a benign adrenocortical tumor with triple secretion of cortisol, androgens, and aldosterone. Development of multiple sclerosis after surgical removal of the tumor

Markou

Tsigou²,

Papadogias³

et al. 2005

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We present a 39-year old female with a benign adrenal tumor characterized by autonomous secretion of cortisol, androgens, and aldosterone. The patient presented with a 4-year history of hypertension and severe hirsutism. Baseline investigations revealed elevated testosterone, androstendione, and 17OH progesterone with normal levels of dehydroepi androsterone sulfate. CT of the adrenals revealed a 2.5x3.0 cm tumor with characteristics of an adenoma on the left adrenal gland. Pelvic ultrasound was normal. Further investigations revealed suppressed basal ACTH levels, loss of diurnal rhythm of cortisol, and failure to suppress on low dose dexamethasone suppression test, suggesting autonomous cortisol secretion by the tumor. She had an exaggerated response of 17OH progesterone to ACTH, implying reduced 21-hydroxylase activity. An elevated plasma aldosterone concentration to plasma renin activity ratio was suggestive of hyperaldosteronism, which was confirmed by failure of aldosterone to suppress to a formal saline infusion test. Complete clinical and biochemical remission of the disease was observed after left adrenalectomy. Histology confirmed the presence of an adrenocortical adenoma. The patient developed multiple sclerosis 6 months after the operation. The flare-up of an autoimmune disease (multiple sclerosis) postoperatively could be coincidental or possibly related to the high normalization of the high cortisol levels acting as a precipitating factor.

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Section: Discussionmentioning

confidence: 98%

“…Mixed cortisol and aldosterone secretion by adrenal adenomas have also been described. 6,7 However, a benign adrenal tumor simultaneously secreting cortisol, aldosterone, and testosterone has not to our knowledge been previously reported. This rare occurrence is herein described.…”

Section: Introductionmentioning

confidence: 95%

A unique case of a benign adrenocortical tumor with triple secretion of cortisol, androgens, and aldosterone. Development of multiple sclerosis after surgical removal of the tumor

Markou

Tsigou²,

Papadogias³

et al. 2005

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“…30 Beginning with the first description in 1979, 7,8 an increasing number of cases with hypercortisolism and PA have been recognized in the recent years, 9-29 mainly in Japan. The majority of the reported cases have had subclinical autonomous glucocorticoid hypersecretion, whereas overt Cushing's syndrome has been found in only six patients.…”

Section: Discussionmentioning

confidence: 99%

Sporadic solitary aldosterone- and cortisol-co-secreting adenomas: endocrine, histological and genetic findings in a subtype of primary aldosteronism

et al. 2010

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Adrenal adenomas producing both aldosterone and cortisol (A/CPAs) have been described in only a few cases. Correct subtype classification is necessary for making therapeutic decisions in primary aldosteronism (PA). Therefore, we studied in detail the clinical, hormonal and histological features of this entity in two patients with A/CPAs. We describe two patients with A/CPA and present their endocrine evaluations at baseline, after suppression with fludrocortisone and dexamethasone, after therapy with spironolactone and after unilateral adrenalectomy. Moreover, the expression of corticotropin (MC2R) and angiotensin II type 1 (AT1R) receptors and 17a-hydroxylase in the tumors of these two patients was analyzed by immunohistochemistry. Aldosterone, 18-hydroxycorticosterone (18-OH-B) and 18-hydroxycortisol (18-OH-F) were not suppressible with fludrocortisone in either patient and were partly suppressible with dexamethasone in one of the patients. Adrenal insufficiency developed in both patients after operation and lasted for more than 6 months. Aldosterone and hybrid corticosteroids returned to normal 8 weeks after adrenalectomy. In both cases, immunostaining showed weak expression of AT1R and MC2R but strong expression of 17a-hydroxylase. The most common germline mutations in the aldosterone synthase gene and the aldosterone synthase/11b-hydroxylase hybrid gene were absent. These two cases document the fact that sporadic A/CPA is a subtype of PA. The presence of an A/CPA should be considered if a patient has both PA and hypercortisolism.

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“…There have been several reports of adrenal cortical adenoma secreting both aldosterone and cortisol, [3][4][5][6] but not many of detailed pathological investigations. 7 To our knowledge the present case is the oldest patient with both PA and pre-CS.…”

Section: Discussionmentioning

confidence: 99%

Primary Aldosteronism Combined With Preclinical Cushing's Syndrome in an Elderly Patient

Fujii

Kamide

Miyake

et al. 2005

Circ J

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Concurrent hypersecretion of aldosterone and cortisol from the adrenal cortical adenoma

Cited by 36 publications

References 2 publications

A unique case of a benign adrenocortical tumor with triple secretion of cortisol, androgens, and aldosterone. Development of multiple sclerosis after surgical removal of the tumor

A unique case of a benign adrenocortical tumor with triple secretion of cortisol, androgens, and aldosterone. Development of multiple sclerosis after surgical removal of the tumor

Sporadic solitary aldosterone- and cortisol-co-secreting adenomas: endocrine, histological and genetic findings in a subtype of primary aldosteronism

Primary Aldosteronism Combined With Preclinical Cushing's Syndrome in an Elderly Patient

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