Clinicopathological features of primary aldosteronism associated with subclinical Cushing’s syndrome

Endocrine Journal

Kiichiro Hiraishi²  Masaru Doi²  Kyoichiro Tsuchiya²  Takanobu Yoshimoto²  Hironobu Sasano¹  Yukio Hirata²  Hajime Izumiyama²  Isao Minami² 

[1] Department of Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School, Tokyo 113-8519, Japan

关键词: Primary aldosteronism;    Subclinical Cushing’s syndrome;    Adrenal venous sampling;    Cortisol replacement;   

DOI  :  10.1507/endocrj.K10E-402

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(34)Cited-By(15)Primary aldosteronism (PA), an autonomous aldosterone hypersecretion from adrenal adenoma and/or hyperplasia, and subclinical Cushing syndrome (SCS), a mild but autonomous cortisol hypersecretion from adrenal adenoma without signs or symptoms of Cuhing’s syndrome, are now well-recognized clinical entities of adrenal incidentaloma.However, the clinicopathological features of PA associated with SCS (PA/SCS) remain unknown.The present study was undertaken to study the prevalence of PA/SCS among PA patients diagnosed at our institute, and characterize their clinicopathlogical features.The prevalence of PA/SCS was 8 of 38 PA patients (21%) studied.These 8 PA/SCS patients were significantly older and had larger tumor, higher serum potassium levels, lower basal plasma levels of aldosterone, ACTH and DHEA-S as well as lower response of aldosterone after ACTH stimulation than those in 12 patients with aldosterone-producing adenoma without hypercortisolism.All 8 PA/SCS patients showed unilateral uptake by adrenal scintigraphy at the ipsilateral side, whereas the laterality of aldosterone hypersecretion as determined by adrenal venous sampling varied from ipsilateral (3), contralateral (2), and bilateral side (2).6 PA/SCS patinets who underwent adrenalectomy required hydrocortisone replacement postoperatively.Histopathological analysis of the resected adrenal tumors from 5 PA/SCS patients revealed a single adenoma in 3, and double adenomas in 2, with varying degrees of positive immunoreactivities for steroidgenic enzymes (3β-HSD, P450C17) by immunohistochemical study as well as CYP11B2 mRNA expression as measured by real-time RT-PCR.In conclusion, PA/SCS consists of a variety of adrenal pathologies so that therapeutic approach differs depending on the disease subtype.

【 授权许可】

Unknown