Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Clin Hypertens (Greenwich). 2021 Nov;23(11):1987-1991. doi: 10.1111/jch.14374. Epub 2021 Oct 17.
Here, we report a case of unilateral adrenal aldosterone and cortisol co-secreting adenoma. A 34-year-old man with a history of severe hypertension for one year was detected hypokalemia (2.42 mmol/L lowest) and unilateral adrenal mass in a size of 71 mm*63 mm. Measurements of plasma aldosterone concentration and plasma renin activity showed marked increases. Primary aldosteronism was diagnosed. To exclude adrenal malignancy, the function of zona fasciculate was evaluated, and 24-h urine free cortisol was found abnormal in a testing. Further examinations revealed that circadian rhythm of serum cortisol disappeared and 2 mg-dexamethasone suppression test was positive. The final diagnosis was secondary hypertension, primary aldosteronism and subclinical Cushing's syndrome. After unilateral adrenalectomy, his blood pressure was normalized and biochemical parameters in the normal range. In conclusion, in patients with a large aldosterone-producing adenoma, the function of zona fasciculate might have to be evaluated for the identification of aldosterone and cortisol co-secreting neoplasms.
在这里，我们报告一例单侧肾上腺醛固酮和皮质醇混合分泌腺瘤。一名 34 岁男性，有一年严重高血压病史，检查发现低钾血症（最低 2.42mmol/L）和单侧 71mm*63mm 大小的肾上腺肿块。血浆醛固酮浓度和血浆肾素活性的测定显示明显增加。诊断为原发性醛固酮增多症。为排除肾上腺恶性肿瘤，评估了束状带的功能，发现 24 小时尿游离皮质醇检查异常。进一步检查发现血清皮质醇的昼夜节律消失，2mg 地塞米松抑制试验阳性。最终诊断为继发性高血压、原发性醛固酮增多症和亚临床库欣综合征。单侧肾上腺切除术后，他的血压正常，生化参数也在正常范围内。总之，在大的醛固酮分泌腺瘤患者中，可能需要评估束状带的功能，以识别醛固酮和皮质醇混合分泌的肿瘤。
