A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone

dA rare case of aldosterone-producing adrenocortical adenoma with preclinic al Gushing's syndrome and hypersecretion of parathyroid hormone (PTH) is de scribed. A 64-year-old male patient had a history of hypertension for two d ecades and hypokalemia for 4 years. He suffered from left hemiparesis and a phasia due to cerebral hemorrhage, but his appearance was not Cushingoid. H is plasma renin activity was below the normal range, while plasma aldostero ne concentration was high. They did not respond to furosemide-upright test. His plasma cortisol level in the morning was at the upper limit of the nor mal range, but it did not show a diurnal rhythm nor was it suppressed by 1 mg and 8 mg of dexamethasone. Computed tomography showed a low density tumo r in the right adrenal gland. An adrenal scintigram under dexamethasone tre atment revealed an uptake of the tracer on the right side, and plasma aldos terone and cortisol concentrations in the adrenal vein were higher on the r ight side than on the opposite. The diagnosis of right aldosterone-producin g adrenal adenoma with an autonomous production of cortisol was confirmed b y right adrenalectomy. Histological findings showed an adenoma consisting m ostly of clear cells, but that the nests of compact cells were scattered. A nalysis of an extract from the adenoma revealed that the adenoma contained an excess amount of aldosterone and that the cortisol/corticosterone ratio was higher than that of aldosterone-producing adenoma. Both serum calcium a nd PTH levels remained high one year after adrenalectomy. Ultrasonography r evealed the swelling of a parathyroid gland on the left side, indicating th e coexistence of an autonomous hyperparathyroidism.