A case report of subclinical primary aldosterone complicating with subclinical Cushing syndrome and literature review

doi:10.16150/j.1671-2870.2023.05.010

Abstract

Abstract:

This case reports a rare subclinical primary aldosteronism complicated with subclinical Cushing’s syndrome. A 41-year-old female patient was admitted for adrenal incidentaloma, had no clinical manifestations of typical primary aldosteronism or Cushing syndrome, such as hypertension, hypokalemia, abnormal glucose metabolism. Laboratory tests indicated ARR> 3.7, ACTH <1.6 pg/mL, and a postoperative pathological diagnosis was adrenal cortical adenoma. Subclinical coexistence of both diseases was presented in this case. This type is not fully recognized in current guidelines and reports, and deserves more detailed discussion.

Key words: Adrenal incidentaloma, Subclinical primary aldosteronism, Subclinical Cushing syndrome

CLC Number:

R586.2
R446

HOU Yiru, WANG Min, WANG Chunhua, CHEN Yujie. A case report of subclinical primary aldosterone complicating with subclinical Cushing syndrome and literature review[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(05): 480-485.

Figures/Tables 7

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References 22

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项目	入院第1天	入院第3天	术后4周
血浆醛固酮浓度（ng/dL）	4.01	7.65	11.4
血浆肾素活性（μIU/mL）	<0.5	0.5	20.0
醛固酮肾素比值	15.3	0.57	无
去甲肾上腺素（pg/mL）	23.4	无	无
肾上腺素（pg/mL）	10.6	无	无

时点	24 h平均（mmHg）		白天清醒时段（mmHg）		夜间睡眠时段（mmHg）		起床后清醒时段（mmHg）		昼夜节律（%）
时点	收缩压	舒张压	收缩压	舒张压	收缩压	舒张压	收缩压	舒张压	收缩压	舒张压
术前	122	80	125	83	122	78	125	83	<0.1	2.5
术后	113	77	118	82	103	66	110	80	12.7	19.5

指标	入院第1天			入院第2天	入院第3天	小剂量地塞米松抑制试验后	术后第1天	术后第4周
指标	8 AM	4 PM	12 PM	无	无	8 AM	8 AM	8 AM
血清皮质醇（μg/dL）	4.82	5.80	3.24	无	无	1.14	15.13	5.83
促肾上腺皮质激素（pg/mL）	<1.6	1.69	无	无	无	无	无	15.11
24小时尿游离皮质醇（μg/24 h）	无	无	无	194.01	175.78	25.41	无	无

项目 SPA合并SCS		Kitajima 报道^[8]病例	本病例
临床表现		49岁女性	41岁女性
		因“肾上腺偶发瘤”入院	因“肾上腺偶发瘤”入院
		无满月脸	无满月脸，无多血质面容
		无中心型肥胖	项背部正中软组织增厚
		无肢体无力	腹部、臀部未见紫纹
既往史		无	无
实验室检查
	血钾（mmol/L）	4.0	3.7
	8 AM皮质醇（μg/dL）	11.7	4.82
	4 PM皮质醇（μg/dL）	无	5.80
	11 PM皮质醇（μg/dL）	3.3	无
	12 PM皮质醇（μg/dL）	无	3.24
	1 mg地塞米松抑制试验后皮质醇（μg/dL）	1.8	无
	小剂量地塞米松抑制试验后皮质醇（μg/dL）	无	1.14
	促肾上腺皮质激素（pg/mL）	<2.0	<1.6
	血浆醛固酮浓度	110 pg/mL	7.65 ng/dL
	血浆肾素活性	0.1 ng/(mL·h)	0.5 μIU/mL
	醛固酮肾素比值	>200	15.3
	卡托普利试验	阳性	无
	盐水负荷试验	阴性	无
CT		双侧肾上腺结节（左侧结节18 mm，右侧结节13 mm）	左侧肾上腺结节（2.5 cm×2.4 cm）
病理		无	手术标本切面呈金黄色，病理诊断为左侧肾上腺肿物皮质腺瘤
治疗		无	手术切除
随访
	血钾、血压	恢复正常	恢复正常
	血浆醛固酮浓度、皮质醇、促肾上腺皮质激素	恢复正常	恢复正常
	血浆肾素活性	受抑制	恢复正常
	醛固酮肾素比值	>200	恢复正常