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Autonomous aldosterone secretion may be more prevalent in hypertensive patients with adrenal incidentaloma
Pappa T. J Clin Endocrinol Metab. 2012;doi:10.1210/jc.2011-2874.
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Hypertensive patients with an adrenal incidentaloma were significantly more likely to have autonomous aldosterone secretion than normotensive counterparts, according to study results.
The researchers aimed to use this case-control study at a tertiary general hospital to further investigate adrenal aldosterone secretory patterns in patients with adrenal adenomas with or without arterial hypertension, according to the results. The study was conducted because there are few data on the incidence of autonomous aldosterone secretion in patients with adrenal incidentalomas.
There were 72 normotensive patients with normal adrenal morphology and 191 patients who were stratified into three groups: normotensive patients with an adrenal incidentaloma (n=46), hypertensive patients with an adrenal incidentaloma (n=89) and hypertensive patients with an adrenal adenoma identified after investigation for arterial hypertension (n=56).
The researchers based evaluation of autonomous cortisol secretion on a low-dose dexamethasone suppression test and autonomous adrenal aldosterone secretion on a modified saline infusion test. The matched control cohort provided normal cutoff levels.
Patients in the hypertensive adrenal incidentaloma group demonstrated significantly higher post-saline infusion test adrenal aldosterone levels and adrenal aldosterone/renin levels than normotensive patients with an incidentaloma.
The prevalence of autonomous aldosterone secretion was calculated by applying the combination of post-modified saline infusion test adrenal aldosterone level and the adrenal aldosterone/renin ratio simultaneously (post-modified saline infusion test cutoffs, adrenal aldosterone levels, 2.41 ng/dL; adrenal aldosterone/renin ratio, 0.35 ng/dL/mcU/mL).
Twelve percent of normotensive patients with an incidentaloma, 36.4% of hypertensive patients with an incidentaloma and 54.2% of hypertensive patients with an adrenal adenoma identified after investigation for arterial hypertension had autonomous aldosterone secretion, based on these cutoffs.
No difference in the prevalence of autonomous cortisol secretion was observed between the three groups.
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