An adrenal cyst associated with 19-nor-deoxycorticosterone excess and low renin hypertension.
Adrenal cysts are rare, but they have been disproportionately associated with hypertension. This report describes a hypertensive patient with increased levels of 19-nor-deoxycorticosterone (19-nor-DOC), a potent mineralocorticoid. The patient was a thirty year old man with hypokalemia, moderately severe hypertension, suppressed PRA, and low aldosterone secretion. Following surgical removal of a 10 cm adrenal cyst, the hypertension improved, the hypokalemia resolved, and the PRA and the aldosterone secretion normalized. Urinary 19-nor-DOC pre-op was elevated 4.6 microgram per day (normal less than 1.0 microgram/day and subsequently became normal at 0.7 microgram per day following surgery. The adrenal cyst was a fibrous walled structure containing mucinous straw-colored fluid. Pericystic adrenocortical tissue demonstrated increased 19-OH-DOC production (a 19-nor-DOC precursor) which may have been responsible for the 19-nor-DOC excess. We hypothesize that compressive adrenal damage from the cyst may produce a form of adrenal regeneration hypertension which is known to be associated with 19-nor-DOC excess.
Griffing
G T
GT
Evans Memorial Department of Clinical Research, Boston University School of Medicine, Massachusetts 02118.
Chobainian
A V
AV
Egdahl
R
R
Ehlers
M E
ME
Melby
J C
JC
D000307:Adrenal Gland Diseases / Q000150:complications / Q000503:physiopathology*; D000328:Adult; D001794:Blood Pressure; D003560:Cysts / Q000150:complications / Q000503:physiopathology*; D003900:Desoxycorticosterone / Q000031:analogs & derivatives* / Q000032:analysis / Q000652:urine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008901:Mineralocorticoids / Q000652:urine; D012083:Renin / Q000502:physiology*
D008901:Mineralocorticoids; D003900:Desoxycorticosterone; C019026:19-nordeoxycorticosterone; D012083:Renin