Background: Occasionally we experienced cases of primary aldosteronism with subclinical Cushing syndrome, many of which showed bilateral aldosterone production and could not be treated by surgery. Primary aldosteronism with subclinical Cushing syndrome had difficulties in subtype classifications by adrenal vein sampling because of its insufficient lateralized indexes. Recently super-selective adrenal vein sampling revealed the various patterns of subtypes in these situations.Design and Method:
Case: A 41-year-old man was admitted to our department for evaluation of hyporenin hyperaldosteronism. An endocrinological investigation showed the coexistence of primary aldosteronism and subclinical Cushing syndrome. Abdominal computed tomography showed a 3 centimeter adenoma in the right adrenal gland. 131I-adosterol scintigraphy showed high uptake in the same side. Super-selective adrenal vein sampling showed an elevated level of aldosterone from one branch of the right adrenal vein, with excess cortisol production in the same one. He was diagnosed as a right aldosterone producing adenoma with subclinical Cushing syndrome, and underwent laparoscopic right aderenalectomy.Results:
Active renin concentration and plasma aldosterone concentration were both normalized after the surgery, and we confirmed a complete cure of primary aldosteronism.Conclusions:
Super-selective adrenal vein sampling enables us to evaluate the subtype classification of primary aldosteronism with subclinical Cushing syndrome. This method could provide such patients with therapeutic options.