Vicennati Valentina, Repaci Andrea, di Dalmazi Guido, Rinaldi Eleonora, Golfieri Rita, Giampalma Emanuela, Minni Francesco, Marrano Nicola, Santini Donatella, Pasquali Renato
Division of Endocrinology, Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, Italy.
Int J Surg Pathol. 2012 Jun;20(3):316-9. doi: 10.1177/1066896911427036. Epub 2011 Nov 8.
A 70-year-old woman was referred to the authors' unit following hospitalization for cardiac failure, high urinary free cortisol concentrations and severe hypokaliemia. A computed tomography scan of the abdomen showed an adrenal adenoma. The 24-hour urinary free cortisol values were high and plasma cortisol levels failed to suppress following 1 mg dexamethasone test. Aldosterone to plasma renin activity ratio was also pathologic, confirmed by saline load. She showed no symptoms of glucocorticoid excess. She was diagnosed with combined primary hyperaldosteronism and Cushing's syndrome. Cases of adrenal incidentalomas co-secreting cortisol and aldosterone are rare; they should be addressed in patients undergoing adrenal surgery for Conn's syndrome to avoid adrenal insufficiency after removal of the tumor.
一名70岁女性因心力衰竭、尿游离皮质醇浓度升高和严重低钾血症住院后被转诊至作者所在科室。腹部计算机断层扫描显示肾上腺腺瘤。24小时尿游离皮质醇值升高，1毫克地塞米松试验后血浆皮质醇水平未能被抑制。醛固酮与血浆肾素活性比值也异常，经盐水负荷试验证实。她没有糖皮质激素过多的症状。她被诊断为原发性醛固酮增多症和库欣综合征合并。肾上腺意外瘤同时分泌皮质醇和醛固酮的病例很少见；对于因Conn综合征接受肾上腺手术的患者应予以关注，以避免肿瘤切除后肾上腺功能不全。
