ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)
Understanding the sources of aldosterone and cortisol production in primary aldosteronism and autonomous cortisol secretion
Eduardo Kawahara 1 , Jessica Okubo 1 , Tatiana Goldbaum 1 , Felipe Ledesma 2 , Jose Chambô 3 , Luiz Bortolotto 4 , Andrea Pio-Abreu 5 , Giovanio Silva 5 , Luciano Drager 5 , Maria Candida Barisson Villares Fragoso 6 , William Nahas 3 , Claudia Zerbini 2 , Ana Claudia Latronico 1 , Berenice Mendonca 6 & Madson Almeida 1
1Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 2Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 3Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 4Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 5Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 6Laboratório de Hormônios e Genética Molecular LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
JOINT1810
Background: Approximately 25% of patients with primary aldosteronism (PA) exhibit mild autonomous cortisol secretion (MACS). Patients with PA and MACS have an increased incidence of cardiovascular events compared to patients with PA without MACS. However, the characterization of aldosterone lateralization, histopathology, and outcomes among patients with PA and MACS is not well established.
Aims: To evaluate the origins of aldosterone and cortisol secretion in patients with PA and MACS who underwent adrenalectomy, and to compare clinical and biochemical aspects, histology and outcomes between PA patients with and without MACS.
Methods: We conducted a cohort study including 197 patients with PA who underwent investigation for MACS using a 1 mg dexamethasone suppression test at a single tertiary center. MACS was characterized by cortisol ≧ 1.8 mcg/dL with dexamethasone levels > 130 ng/dL. Histology was investigated using CYP11B2 and CYP11B1 immunostaining in adrenal lesions.
Results: MACS was diagnosed in 52 (26.4%) out of 197 patients with PA. Among the 52 patients with MACS, 29 (55.8%) underwent adrenal venous sampling (AVS) under cosyntropin stimulation, and 25 (48.1%) underwent surgical treatment. Patients with PA and MACS were statistically significantly older at the time of PA diagnosis compared to patients with isolated PA (57.15 [range] vs. 52.58 [range] years; P=X). Other clinical and biochemical features at diagnosis and PASO outcomes were not different between the two groups. Moreover, the frequency of unilateral and bilateral PA was X% and Y% in patients with PA and MACS, respectively. Interestingly, aldosterone and cortisol were produced by different adrenal lesions in 7 (38.9%) out of 18 cases with immunostaining (unilateral cortisol secretion and bilateral PA): a unilateral cortisol-producing adenoma (positive for CYP11B1 and negative for CYP11B2) and bilateral aldosterone-producing nodules or micronodules (positive only for CYP11B2). Eleven (61.1%) out of 18 patients had an aldosterone lesion (adenoma or nodule?) producing both aldosterone and cortisol.
Conclusion: For the first time, we demonstrate that aldosterone and cortisol originate from distinct adrenal lesions in nearly 40% of patients with PA and MACS. This finding has critical implications for the interpretation of AVS and the planning of surgical treatment. Support: Sao Paulo Research Foundation (FAPESP) grant 2019/15873-6 (to M.Q.A.)
Volume 110
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2025 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more