Endocrine Abstracts

JOINT3643

Introduction: Hypertension is a major health condition, primarily classified as essential. However, secondary causes, particularly endocrine etiologies, should be considered in specific clinical contexts, such as resistant hypertension. Endocrine etiologies include hyperaldosteronism, Cushing syndrome, and pheochromocytoma among other causes. The association between primary hyperaldosteronism and Cushing’s syndrome, though uncommon, represents a documented clinical entity. This case series aims to elucidate the clinical presentations, hormonal profiles, and imaging findings of patients diagnosed with this uncommon association.

Methods: We conducted a retrospective study about patients diagnosed with endocrine hypertension due to association of Cushing syndrome and primary hyperaldosteronism. Clinical data, laboratory findings and imaging results were analyzed.

Results: We present four cases of patients (three men and one woman) referred to our department for the evaluation of secondary hypertension. The average age of the patients was 47 years (28-68). In 75% of cases, hypertension was classified as grade 3, and all patients exhibited hypokalemia, with potassium levels as low as 2 mmol/l (2-3.4). Plasma metanephrine testing returned negative results in all cases. Hormonal assessments indicated primary hyperaldosteronism, with a mean aldosterone level of 644 pg/mL(502 - 1354) and a mean aldosterone-to-renin ratio of 300 (116 - 433). The diagnosis of Cushing’s syndrome was confirmed in all patients through a low-dose dexamethasone suppression test, yielding a mean cortisol level of 25 µg/dL. Notably, Cushing’s syndrome was found to be ACTH-dependent in two patients, with a ACTH level of 26 pg/mL and 23. Adrenal imaging revealed bilateral adrenal hyperplasia in one patient (ACTH independent), adrenal vein catheterization demonstrated lateralized secretion to the right adrenal gland. The Other patients presented with adrenal nodules; one patient had bilateral nodules. The mean size of these nodules was 17 mm.

Conclusion: The coexistence of Cushing’s syndrome and primary hyperaldosteronism is rare. Both conditions are characterized by distinct pathophysiological mechanisms leading to increased blood pressure and electrolyte imbalances. Their simultaneous occurrence poses unique diagnostic and therapeutic challenges, underscoring the importance of a comprehensive evaluation when endocrine etiologies are suspected.