title: Deoxycorticosterone-producing adenoma concomitant with aldosterone-producing microadenoma: a challenging combination.
abstract: OBJECTIVE
  To describe the challenging case of a 59-year-old male with a deoxycorticosterone (DOC)-producing adrenal adenoma concomitant with an aldosterone-producing microadenoma.
  
  
  METHODS
  We measured the patient's aldosterone and progesterone levels during adrenal venous sampling (AVS). The steroidogenic enzyme expression was studied with in situ hybridization (ISH). Steroids profiles were determined in the peripheral serum obtained before and after the operation, as well as in the main adrenal tumor.
  
  
  RESULTS
  The patient was diagnosed with primary aldosteronism (PA) based on typical clinical findings. He had an adrenal tumor located at the lower pole of the left adrenal gland. The aldosterone concentration in the adrenal vein proximal to the adrenal tumor was higher than that of the ipsilateral adrenal vein distal to the tumor during the AVS. Progesterone was only elevated in the adrenal vein proximal to the tumor, suggesting that the tumor produced steroids other than aldosterone. The postoperative findings revealed that the main tumor was accompanied by 2 microadenomas. The main adrenal tumor was diagnosed as a DOC-producing adenoma, and one of the microadenomas was diagnosed as aldosterone-producing based on the ISH and the determination of the steroid profiles.
  
  
  CONCLUSIONS
  Concomitant PA masked the key findings of a DOC-producing tumor; the suppression of aldosterone in this patient. Multiple sampling in the adrenal vein considering the location of the adrenal tumor provided a clue to the diagnosis. Progesterone measurement during AVS is easy and may be useful in diagnosing rare adrenal tumors that produce intermediate products in adrenal steroid biosynthesis.
authors.affiliation: Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Oyama
authors.affiliation: Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Nozaki
authors.affiliation: Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Horie
authors.affiliation: Department of Pathology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Shigematsu
authors.affiliation: Department of Nephro-urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Takehara
authors.affiliation: Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ando
authors.affiliation: Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000236:Adenoma; D000310:Adrenal Gland Neoplasms; D000311:Adrenal Glands; D000450:Aldosterone; D006801:Humans; D006929:Hyperaldosteronism; D008297:Male; D008875:Middle Aged
chemical_list: D000450:Aldosterone