Small adrenal tumors in primary aldosteronism may signal subclinical Cushing’s syndrome
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In rare cases of a concurrence of primary aldosteronism and subclinical Cushing’s syndrome, the two conditions did not exhibit any additive or synergic impact on glucose or potassium metabolism or maximum tumor diameter, according to findings published in BMC Endocrine Disorders.
“Some challenge tests required for the definite diagnosis of subclinical Cushing’s syndrome should be conducted for the suspected concurrence of subclinical Cushing’s syndrome in people with primary aldosteronism,” Shigemitsu Yasuda, MD, of the department of endocrinology and diabetes at Saitama Medical University, told Healio. “An adrenal adenoma causing the overproduction of both cortisol and aldosterone is considered to have a diameter greater than 2.5 cm diameter. In the present study, however, the adrenal tumor was smaller in both patients with subclinical Cushing’s syndrome and those with patients with primary aldosteronism plus subclinical Cushing’s syndrome.”
In a retrospective study, Yasuda and colleagues analyzed data from 71 adults who developed primary aldosteronism (n = 45), subclinical Cushing’s syndrome (n = 12) or primary aldosteronism plus subclinical Cushing’s syndrome (n = 14), from Saitama Medical University Hospital in Japan between 1999 and 2016 (mean age, 58 years; 47 women). Main outcome measures were the proportion of participants with diabetes, serum potassium concentration and maximum tumor diameter on CT scans.
Researchers found that the proportion of adults with diabetes was greater among those with primary aldosteronism plus subclinical Cushing’s syndrome vs. those with primary aldosteronism alone (50% vs. 13.9%; P < .05). There was no difference in diabetes incidence between those with primary aldosteronism plus subclinical Cushing’s syndrome vs. those with subclinical Cushing’s alone.
Serum potassium concentration was lower among those with primary aldosteronism plus subclinical Cushing’s syndrome vs. adults with subclinical Cushing’s syndrome (mean, 3.3 mEq/L vs. 4 mEq/L; P < .01), without a significant difference between adults with primary aldosteronism plus subclinical Cushing’s syndrome vs. those with primary aldosteronism alone.
Among the three study groups of adults with a unilateral adrenal tumor, maximum tumor diameter was greater among those with primary aldosteronism plus subclinical Cushing’s syndrome vs. those with primary aldosteronism alone (mean, 2.7 cm vs. 1.4 cm; P < .001), without a significant difference between the patients with primary aldosteronism plus subclinical Cushing’s syndrome and patients with subclinical Cushing’s syndrome.
“In our study, the smallest maximum tumor diameters were 1.1 cm in patients with primary aldosteronism plus subclinical Cushing’s syndrome,” Yasuda said. “This result indicates that the possibility of primary aldosteronism plus subclinical Cushing’s syndrome is never discarded, even when maximum tumor diameter is less than 2 cm.” – by Regina Schaffer
For more information:
Shigemitsu Yasuda, MD, can be reached at the Department of Endocrinology and Diabetes, Saitama Medical University, Morohongo 38, Moroyama, Iruma-gun, Saitama 350-0495; Japan; email: syasuda@saitama-med.ac.jp.
Disclosures: The authors report no relevant financial disclosures.
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