A Case of Cortisol Producing Adrenal Adenoma Associated with a Latent Aldosteronoma: Usefulness of the ACTH Loading Test for the Detection of Covert Aldosteronism in Overt Cushing Syndrome

Daisuke Kukidome; Nobuhiro Miyamura; Kourin Sakakida; Seiya Shimoda; Yoshinori Shigematu; Kazuhiko Nishi; Yasuyuki Yamashita; Masatoshi Eto; Hironobu Sasano; Eiichi Araki

doi:10.2169/internalmedicine.51.5597

CASE REPORTS

A Case of Cortisol Producing Adrenal Adenoma Associated with a Latent Aldosteronoma: Usefulness of the ACTH Loading Test for the Detection of Covert Aldosteronism in Overt Cushing Syndrome

Daisuke Kukidome, Nobuhiro Miyamura, Kourin Sakakida, Seiya Shimoda, Yoshinori Shigematu, Kazuhiko Nishi, Yasuyuki Yamashita, Masatoshi Eto, Hironobu Sasano, Eiichi Araki

Author information

Daisuke Kukidome
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan
Nobuhiro Miyamura
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan
Kourin Sakakida
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan
Seiya Shimoda
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan
Yoshinori Shigematu
Department of Diagnostic Imaging, Faculty of Life Sciences, Kumamoto University, Japan
Kazuhiko Nishi
Department of Urology, Faculty of Life Sciences, Kumamoto University, Japan
Yasuyuki Yamashita
Department of Diagnostic Imaging, Faculty of Life Sciences, Kumamoto University, Japan
Masatoshi Eto
Department of Urology, Faculty of Life Sciences, Kumamoto University, Japan
Hironobu Sasano
Department of Pathology, Tohoku University School of Medicine, Japan
Eiichi Araki
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan

Keywords: Cushing syndrome with latent hyperaldosteronism, ACTH loading test

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 4 Pages 395-400

DOI https://doi.org/10.2169/internalmedicine.51.5597

Details

Abstract

A 36-year-old woman with Cushing syndrome was evaluated for coexisting hyperaldosteronism, which was suggested by an abnormal response of the aldosterone-to-cortisol ratio in peripheral blood to the ACTH-administration despite a low basal aldosterone-to-renin ratio. Computed tomography revealed two independent tumors in the left adrenal gland, and adrenal venous sampling indicated hyperaldosteronism in addition to hypercortisolism in the same side. Postsurgical study including immunohistochemical analysis of steroidogenic enzymes suggested one adenoma to be cortisol-producing and the other, aldosterone-producing. The comorbidity of these different hormone-producing adenomas is not rare and careful pre-surgical evaluation is necessary to avoid post-surgical exacerbation of latent hyperaldosteronism.

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