ICEECE2012 Poster Presentations Adrenal cortex (113 abstracts)
Primary aldosteronism associated with subclinical Cushing syndrome
H. Tatsuoka 1 , S. Honjo 1 , Y. Hamamoto 1 , Y. Ohgita 1 , K. Mori 1 , K. Fujimoto 1 , A. Matsuoka 1 , H. Ikeda 1 , Y. Wada 1 , T. Nishikawa 2 , H. Sasano 3 & H. Koshiyama 1
1Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan; 2Yokohama Rosai Hospital, Yokohama, Japan; 3Tokoku University Hospital, Sendai, Japan.
Introduction: It has been reported that primary aldosteronism(PA) is often associated with subclinical Cushing syndrome (SCS). In the present study, we investigated the frequency of SCS in subjects with PA.
Method: Subjects included consecutive patients (n=43) who were diagnosed as PA between 2003 and 2011 in our institute. They were screened by plasma renin activity (PRA (ng/ml/h)) plasma aldosterone concentration (PAC (pg/mL)) ratio (ARR) above 200. The endocrinological examinations such as furosemide posture test, captopril suppression test and low-dose (1 mg) and high-dose (8 mg) dexamethasone suppression test (DST), were performed. The cases of possible diagnosis of PA underwent adrenal vein sampling (AVS) and the laparoscopic adrenalectomy. The diagnosis of PA was confirmed by the pathological findings.
Result: In 43 subjects who were diagnosed as PA, five (11.6%) showed no suppression in low-dose DST, and four of them were also positive in high-dose DST, indicating the presence of SCS, which was confirmed by pathological examination. One case was associated with overt Cushing syndrome (CS). In all of the five cases 24 h urinary cortisol secretion was abnormally high. However, four of five cases showed normal serum cortisol at morning, and two of five cases maintained normal circadian cortisol variations. Postoperatively, three cases needed replacement therapy of hydrocortisone, while no subjects without SCS needed it.
Conclusion: PA is frequently associated with SCS with prevalence of more than 10% in our study. Since it requires postoperative hydrocortisone replacement therapy, our data suggest the importance of routine screening of SCS with DST in PA cases.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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