Primary hyperaldosteronism with concomitant cortisol secretion

Abstract

Aim – to study the diagnostic possibilities of comparative selective venous blood sampling from the central adrenal vein in patients with primary hyperaldosteronism with combined autonomous cortisol secretion. Material and methods. The study included 7 patients with primary hyperaldosteronism with combined autonomous secretion of cortisol who were treated in the clinic from 2010 to 2019. Results. In 72 operated patients with primary hyperaldosteronism, 7 (9.7%) were diagnosed with autonomous secretion of cortisol. The frequency of discrepancy between the intrascopic picture and comparative selective blood sampling in patients with combined autonomous aldosterone-cortisol secretion was 57.1%. Performing comparative selective blood sampling in patients with Connshing syndrome makes it possible to establish the side of hyperproduction of aldosterone and cortisol in bilateral adrenal adenoma with unilateral hormone production. Postoperative adrenal insufficiency was observed in 28.6% of patients Connshing syndrome. Mixed adrenal adenomas can be a source of joint hypersecretion of aldosterone and cortisol. Conclusions. In all patients with primary hyperaldosteronism, it is necessary to exclude the joint autonomous production of cortisol, which allows for a correct assessment of the results of comparative selective blood sampling, with subsequent choice of the intervention side and predict the risk of postoperative adrenal insufficiency.

Keywords

• primary hyperaldosteronism
• autonomous secretion of cortisol
• combined secretion of aldosterone and cortisol
• mixed adenoma
• comparative selective blood sampling from the veins of the adrenal gland
• aldosteroma and cortisol-producing adenoma in bilateral adrenocortical adenoma