Primary hyperaldosteronism in a patient with autonomous cortisol secretion and bilateral adrenal adenomas

Background. Formations of the adrenal cortex may have mixed secretion and produce aldosterone and cortisol. The number of clinical cases of combined secretion of aldosterone and cortisol (the so-called Conching syndrome) is increasing. Most often, the clinical picture is dominated by signs of primary hyperaldosteronism with the development of arterial hypertension and hypokalemia, and autonomous cortisol secretion does not lead to the formation of clinical signs of Itsenko – Cushing syndrome. When examining patients with adrenal cortex formations, signs that allow us to suspect mixed hormonal secretion of these formations are the absence of suppression of cortisol secretion against the background of a night test with 1 mg of dexamethasone and the size of the adrenal gland formation is more than 2.5 cm. With the combined production of aldosterone and cortisol, there is a feature of the management of such patients due to their tendency to metabolic disorders, which consists in the need for a short period of replacement therapy with glucocorticoids in the postoperative period with a decrease in cortisol levels.

Results. In the described clinical case, the patient revealed bilateral formations of the adrenal cortex with mixed secretion of cortisol and aldosterone. The revealed autonomous cortisol secretion was not accompanied by a clear clinical picture characteristic of the Itsenko – Cushing syndrome. However, due to the fact that cortisol-associated diseases and conditions (arterial hypertension, impaired glucose tolerance, weight gain) showed negative dynamics, a comparative selective blood sampling from the adrenal veins was carried out to determine the functionally dominant side of the lesion, which could subsequently become the object of surgical intervention. Taking into account the decrease in renin levels and the result of the saline sample, the level of aldosterone in the adrenal veins was also investigated. Primary hyperaldosteronism was detected accidentally with a distinct lateralization of aldosterone secretion on the right.

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