Association of adrenal medullar and cortical nodular hyperplasia: a report of two cases with clinical and morpho-functional considerations.
Arterial hypertension of adrenal etiology is mainly attributed to primary hyperaldosteronism. However, subtle expressions of hyperadrenergic or glucocorticoid excess can also generate arterial hypertension. The present report describes two hypertensive patients cataloged as resistant essential hypertensives, in whom adrenal masses were found incidentally, who highlight the need to recognize these tenuous clinical or laboratory presentations. Case 1 was a 50-yr-old female with hyperadrenergic hypertension associated to a left adrenal node, normal cortisol and aldosterone:renin ratio, marginally increased urinary normetanephrine, and a positive 131I MIBG radioisotope scan. Adrenalectomy normalized blood pressure and urinary metanephrines. Pathology showed a hyperplastic adrenal medulla associated to a multinodular cortical hyperplasia. Case 2 was a 62- yr-old female with progressive hypertension, a slight Cushing phenotype, non-suppressible hypercortisolism, normal urinary metanephrines, and bilateral adrenal nodes. Bilateral adrenalectomy and subsequent replacement normalized blood pressure and phenotypic stigmata. Pathology demonstrated bilateral cortical multinodular hyperplasia and medullary hyperplasia. The clinical study in both patients was negative for MEN. The apparently rare association of cortical and medullary lesions presented by both patients is probably overlooked in routine pathology exams, but should be meticulously searched since the crosstalk between the adrenal cortex and medulla may prompt dual abnormalities.
Valdés
Gloria
G
Departamentos de Nefrología, Anatomía Patológica, Endocrinología, Urología, y Radiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. gvaldes@med.puc.cl
Roessler
Eric
E
Salazar
Iván
I
Rosenberg
Helmar
H
Fardella
Carlos
C
Martínez
Pedro
P
Velasco
Alfredo
A
Velasco
Soledad
S
Orellana
Pilar
P
D000307:Adrenal Gland Diseases / Q000150:complications* / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis; D000311:Adrenal Glands / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000175:diagnosis; D006973:Hypertension / Q000209:etiology*; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis