title: Combined aldosterone and cortisol secretion by adrenal incidentaloma.
abstract: A 70-year-old woman was referred to the authors' unit following hospitalization for cardiac failure, high urinary free cortisol concentrations and severe hypokaliemia. A computed tomography scan of the abdomen showed an adrenal adenoma. The 24-hour urinary free cortisol values were high and plasma cortisol levels failed to suppress following 1 mg dexamethasone test. Aldosterone to plasma renin activity ratio was also pathologic, confirmed by saline load. She showed no symptoms of glucocorticoid excess. She was diagnosed with combined primary hyperaldosteronism and Cushing's syndrome. Cases of adrenal incidentalomas co-secreting cortisol and aldosterone are rare; they should be addressed in patients undergoing adrenal surgery for Conn's syndrome to avoid adrenal insufficiency after removal of the tumor.
authors.affiliation: Division of Endocrinology, Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, 40138 Bologna, Italy. vicennati@aosp.bo.it
authors.forename: Valentina
authors.initials: V
authors.lastname: Vicennati
authors.forename: Andrea
authors.initials: A
authors.lastname: Repaci
authors.forename: Guido
authors.initials: G
authors.lastname: di Dalmazi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Rinaldi
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Emanuela
authors.initials: E
authors.lastname: Giampalma
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
authors.forename: Nicola
authors.initials: N
authors.lastname: Marrano
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Renato
authors.initials: R
authors.lastname: Pasquali
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism*; D000368:Aged; D000450:Aldosterone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D006929:Hyperaldosteronism / Q000209:etiology / Q000601:surgery; D024821:Metabolic Syndrome / Q000150:complications; D009765:Obesity / Q000150:complications
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone