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KMID : 0356620150300040607
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Journal of Korean Society of Endocrinology
2015 Volume.30 No. 4 p.607 ~ p.613
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Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently
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:Lee Seung-Eun
:Kim Jae-Hyeon/:Lee You-Bin/:Seok Hye-Ri/:Shin In-Seub/:Eun Yeong-Hee/:Kim Jung-Han/:Oh Young-Lyun
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Abstract
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A 31-year-old woman was referred to our hospital with symptoms of hypertension and bilateral adrenocortical masses with no feature of Cushing syndrome. The serum aldosterone/renin ratio was elevated and the saline loading test showed no suppression of the plasma aldosterone level, consistent with a diagnosis of primary hyperaldosteronism. Overnight and low-dose dexamethasone suppression tests showed no suppression of serum cortisol, indicating a secondary diagnosis of subclinical Cushing syndrome. Adrenal vein sampling during the low-dose dexamethasone suppression test demonstrated excess secretion of cortisol from the left adrenal mass. A partial right adrenalectomy was performed, resulting in normalization of blood pressure, hypokalemia, and high aldosterone level, implying that the right adrenal mass was the main cause of the hyperaldosteronism. A total adrenalectomy for the left adrenal mass was later performed, resulting in a normalization of cortisol level. The final diagnosis was bilateral adrenocortical adenomas, which were secreting aldosterone and cortisol independently. This case is the first report of a concurrent cortisol-producing left adrenal adenoma and an aldosterone-producing right adrenal adenoma in Korea, as demonstrated by adrenal vein sampling and sequential removal of adrenal masses.
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KEYWORD
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Adrenocortical adenoma, Hyperaldosteronism, Cushing syndrome
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