title: A Rare Case of Subclinical Primary Aldosteronism and Subclinical Cushing's Syndrome without Cardiovascular Complications.
abstract: We report a rare case of subclinical primary aldosteronism (PA) and subclinical Cushing's syndrome (CS). A 49-year-old woman was referred to our hospital for the evaluation of an adrenal incidentaloma. The patient had no previous medical history and no family history of notable illness. Her blood pressure was 103/60 mmHg. She had no Cushingoid features. Routine laboratory examinations were within the normal ranges including normokalemia. Based on the endocrinological results and imaging findings, we finally made a diagnosis of subclinical PA caused by both adrenal glands and subclinical CS caused by bilateral adrenal tumors. Interestingly, this patient had no risk factors for cardiovascular disease. In addition, the optimal management of patients with subclinical CS and subclinical PA has not been established. Therefore, we are observing her without medical therapy. Four years after diagnosis, no cardiovascular complications have been detected, including cerebral infarction, chronic kidney disease, cardiomegaly on echocardiography, and atherosclerosis on carotid ultrasonography. One important question is why the excessive hormone secretion did not affect the cardiovascular status of this patient. In this regard, we discuss several possible mechanisms including mineralocorticoid resistance and glucocorticoid sensitivity.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Kitajima
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Iseharashi, Kanagawa 259-1193, Japan. tsekimdpdd@tokai-u.jp.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Seki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yasuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Oki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Hanai
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications; D000450:Aldosterone; D002318:Cardiovascular Diseases; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D033162:Incidental Findings; D008875:Middle Aged; D008901:Mineralocorticoids; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids; D008901:Mineralocorticoids; D000450:Aldosterone