Pattern of adrenal hormonal secretion in patients with adrenal adenomas: the relevance of aldosterone in arterial hypertension.
BACKGROUND
Approximately 10% of hypertensives are considered to exhibit autonomous aldosterone secretion (AAS). Although adrenal incidentalomas (AI) can be found in up to 19% of hypertensive individuals, data on the incidence of AAS in hypertensive patients with AI remain scarce.


OBJECTIVE
The aim was to study adrenal aldosterone (ALD) secretory pattern in patients with adrenal adenomas with and without arterial hypertension.


METHODS
We conducted a case-control study in a tertiary general hospital.


METHODS
We investigated 72 normotensive subjects with normal adrenal morphology and 191 subjects divided in three groups: 46 normotensive individuals with an AI (NAI), 89 hypertensive patients with an AI (HAI), and 56 hypertensive patients with an adrenal adenoma identified after investigation for arterial hypertension (HAA). Evaluation of autonomous cortisol secretion was based on a low-dose dexamethasone suppression test. Autonomous ALD secretion was based on a modified saline infusion test (MSI). Normal cutoff levels were obtained from the control matched population.


RESULTS
Post-MSI ALD levels and the ALD/renin (REN) ratios were significantly elevated in HAI and HAA patients compared to NAI subjects. To evaluate the prevalence of AAS, we applied the combination of post-MSI ALD level and the ALD/REN ratio simultaneously (post-MSI cutoffs, ALD levels, 2.41 ng/dl; ALD/REN ratio, 0.35 ng/dl/μU/ml). Based on these cutoffs, 12% of NAI, 36.4% of HAI, and 54.2% of HAA patients had AAS. The prevalence of autonomous cortisol secretion did not differ among the three groups.


CONCLUSIONS
Using a MSI test, we found a remarkably increased prevalence of AAS in hypertensive patients with adrenal adenomas, even when the latter represented an incidental finding.
Department of Endocrinology and Diabetes Center, Athens General Hospital "G. Gennimatas," 154 Mesogion Avenue, 11527 Athens, Greece.
Theodora
T
Pappa
Labrini
L
Papanastasiou
Gregory
G
Kaltsas
Athina
A
Markou
Panayiotis
P
Tsounas
Ioannis
I
Androulakis
Vaios
V
Tsiavos
George
G
Zografos
Kyriakos
K
Vamvakidis
Christianna
C
Samara
George
G
Piaditis
D000302:Adrenal Cortex / Q000378:metabolism / Q000503:physiopathology; D000305:Adrenal Cortex Hormones / Q000097:blood / Q000378:metabolism* / Q000652:urine; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000652:urine; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000652:urine; D018246:Adrenocortical Adenoma / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology / Q000652:urine; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D001158:Arteries / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism / Q000652:urine; D006973:Hypertension / Q000097:blood* / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics
D000305:Adrenal Cortex Hormones; D000450:Aldosterone; D006854:Hydrocortisone