title: Clinicopathological features of primary aldosteronism associated with subclinical Cushing's syndrome.
abstract: Primary aldosteronism (PA), an autonomous aldosterone hypersecretion from adrenal adenoma and/or hyperplasia, and subclinical Cushing syndrome (SCS), a mild but autonomous cortisol hypersecretion from adrenal adenoma without signs or symptoms of Cuhing's syndrome, are now well-recognized clinical entities of adrenal incidentaloma. However, the clinicopathological features of PA associated with SCS (PA/SCS) remain unknown. The present study was undertaken to study the prevalence of PA/SCS among PA patients diagnosed at our institute, and characterize their clinicopathlogical features. The prevalence of PA/SCS was 8 of 38 PA patients (21%) studied. These 8 PA/SCS patients were significantly older and had larger tumor, higher serum potassium levels, lower basal plasma levels of aldosterone, ACTH and DHEA-S as well as lower response of aldosterone after ACTH stimulation than those in 12 patients with aldosterone-producing adenoma without hypercortisolism. All 8 PA/SCS patients showed unilateral uptake by adrenal scintigraphy at the ipsilateral side, whereas the laterality of aldosterone hypersecretion as determined by adrenal venous sampling varied from ipsilateral (3), contralateral (2), and bilateral side (2). 6 PA/SCS patinets who underwent adrenalectomy required hydrocortisone replacement postoperatively. Histopathological analysis of the resected adrenal tumors from 5 PA/SCS patients revealed a single adenoma in 3, and double adenomas in 2, with varying degrees of positive immunoreactivities for steroidgenic enzymes (3β-HSD, P450(C17)) by immunohistochemical study as well as CYP11B2 mRNA expression as measured by real-time RT-PCR. In conclusion, PA/SCS consists of a variety of adrenal pathologies so that therapeutic approach differs depending on the disease subtype.
authors.affiliation: Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School, Tokyo 113-8519, Japan.
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Hiraishi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Kyoichiro
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Isao
authors.initials: I
authors.lastname: Minami
authors.forename: Masaru
authors.initials: M
authors.lastname: Doi
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumiyama
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hirata
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000201:enzymology / Q000378:metabolism*; D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis; D001794:Blood Pressure / Q000502:physiology; D003480:Cushing Syndrome / Q000378:metabolism* / Q000601:surgery; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics / Q000378:metabolism*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000378:metabolism*; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012313:RNA / Q000737:chemistry / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed
chemical_list: D012313:RNA; D019405:Cytochrome P-450 CYP11B2