Journal
MEDICINE
Volume 101, Issue 32, Pages -Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000030008
Keywords
adrenal tumor; cosecretion; Immunohistochemistry; primary aldosteronism; subclinical Cushing's syndrome
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Funding
- Discipline Excellence Development 1.3.5 Project of West China Hospital, Sichuan University [ZYGD18022]
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This study reports the clinical features and immunohistochemistry results of two patients with A/CPA, revealing the relationship between A/CPA and calcium metabolism disorders. These findings provide new clues for the pathogenesis of the disease and emphasize the importance of including A/CPA in the classification of PA.
Rationale: Primary aldosteronism (PA), including aldosterone and cortisol producing adenoma (A/CPA), is the most common trigger of secondary hypertension. The prevalence of A/CPA may be higher than what we could recognize previously with similar studies, but only a few relevant immunohistochemical reports have confirmed this information. Collecting more clinical features and immunohistochemistry data may help us to understand A/CPA, which is very important for avoiding misdiagnosis and improving outcomes in patients with A/CPA. Patient concerns: Both individuals included in this study had hypertension for >10 years. Computed tomography scans revealed the presence of adrenal nodules 1 year ago in patient A and 10 months ago in patient B (based on the date of the final version of this report). The relevant clinical features support PA accompanied by subclinical Cushing syndrome. Diagnosis: Aldosterone and cortisol producing adenoma. Interventions: The adrenal adenoma on the affected side was removed and pathological examination and immunohistochemistry were performed. Both the patients received short-term hydrocortisone treatment. Outcomes: The blood pressure of both patients improved after surgery. Cytochrome P450 (CYP)11B1, CYP11B2, parathyroid hormone receptor 1 (PTH1R), calcium-sensing receptor (CaSR), and vitamin D3 receptor (VD3R) were all positively expressed, but the histopathological features of the expression region differed. Lessons: The occurrence of A/CPA may be related to calcium metabolism disorders. For A/CPA, the diversity in immunohistochemistry suggests many uncertainties regarding the pathogenesis of the disease. A/CPA should be considered in new clinical and pathological classifications of PA to gain more attention from the medical community.
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