Abstract
We identified a left adrenal tumor, left renal atrophy, and left renal artery stenosis (RAS) in a 52-year-old man by MRI/magnetic resonance angiography (MRA) during evaluation of hypertension. Laboratory tests revealed hypokalemia, a high plasma aldosterone concentration (PAC), low plasma renin activity (PRA), and normal plasma cortisol. An excessive response of aldosterone and cortisol to adorenocorticotrophic hormone (ACTH) was found upon selective sampling of the left adrenal vein. Selective renal venous sampling showed a left/right renal venous PRA ratio of 1.7. A dexamethasone (8 mg) suppression test showed insufficient suppression of cortisol. We diagnosed this patient as having aldosterone-producing adrenal adenoma (APA) associated with renovascular hypertension (RVH) and preclinical Cushing's syndrome. As an initial treatment, percutaneous transluminal renal angioplasty was performed. Postoperatively, the patient's blood pressure decreased. One month later, the tumor was removed by complete laparoscopic left adrenalectomy. Postoperatively, blood pressure decreased further and both PAC and PRA were normalized. However, antihypertensive therapy could not be completely stopped. The renal dysfuntion that occurred prior to treatment seemed to prevent complete normalization of blood pressure.
Similar content being viewed by others
Article PDF
References
Preston RA, Epstein M : Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens 1997; 5: 1365–1377.
Nakada T, Koike H, Akiya T, et al: Therapeutic results of primary aldosteronism with special reference to renal or renovascular lesions. Int Urol Nephrol 1988; 20: 67–76.
Hoet JJ, Molineaux L : Conn's syndrome: the effect of amphenone. Acta Endocrinol 1960; 33: 375–387.
Laidlaw JC, Yendt ER, Gornall A : Hypertension caused by renal artery occlusion simulating primary aldosteronism. Metabolism 1960; 9: 612–623.
Bloch HS : Hypertension, bilateral renal artery stenosis, adrenocortical adenomas, and normal serum electrolyte levels. JAMA 1966; 196: 622–624.
Christenson WB, Kauiman JJ, Gonick HC : Co-existing aldosterone-producing adrenal tumor (aldosteronoma) and bilateral renovascular lesions. J Urol 1969; 101: 1–7.
Mills IH, Cook RF, Galley JM, Edwards OM, Tait AD : Corticosterone-secreting tumors: with and without renal artery stenosis. Clin Endocrinol 1980; 13: 355–360.
Vircburger MI, Prelevic GM, Todorovic P, Bojic P, Peric LA, Paunkovic N : Renovscular hypertension associated with bilateral aldosteronoma. Postgrad Med J 1984; 60: 533–536.
Santangelo K, Cheung JY, Gifford RR, Thiele BL, Yang HC : The simultaneous occurrence of renal artery stenosis and an aldosteronoma in a patient with hypertension. Am J Kidney Dis 1989; 14: 520–523.
Takenaka T, Nishikawa A, Nakahara K, Hattori S, Yokokawa T, Izawa A : A case of primary aldosteronism with renovascular hypertension. Jpn J Med 1990; 4: 429–432.
Ghilardi G, Pizzocari P, Bortolani E, Monti M DE, Longhi F : The concomitance of renal artery stenosis and Conn's adenoma in a hypertensive woman. Panminerva Med 1991; 33: 53–56.
Cheung YK, Chan FL, Lam KSL : Aldosteronoma coexisting with renal artery stenosis in secondary hypertension. Urol Radiol 1992; 13: 228–232.
Stokes GS, Monaghan JC, Roche J, Grunstein H, Gordon RD : Concurrence of primary aldosteronism and renal artery stenosis. Clin Exp Pharmacol Physiol 1992; 19: 300–303.
Chowdhury TA, Lasker SS : Coexisting renal artery stenosis and primary aldosteronism. Nephrol Dial Transplant 1997; 12: 2735–2736.
Mattix H, Dennard DT, Hall D : Fibromuscular dysplasia of the renal artery and adrenal adenoma in a 36-year-old woman with hypertension. Am J Med Sci 1997; 314: 51–53.
Mansoor GA, Tendler BE, Anwar YA, Uwaifo G, White WB : Coexistence of atherosclerotic renal artery stenosis with primary hyperaldosteronism. J Hum Hyperens 2000; 14: 151–153.
Glodny B, Cromme S, Wortler K, Herwig R, Kisters K, Winde G : Conn's syndrome and bilatelal renal artery stenosis in the presence of multiple renal arteries. J Endocrinol Invest 2001; 24: 268–273.
Karagiannis A, Tziomalos K, Dona K, et al: Bilateral renal artery stenosis and primary aldosteronism in a diabetic patient. QJM 2005; 98: 913–918.
Pizzolo F, Pavan C, Guarini P, et al: Primary hyperaldosteronism: a frequent cause of residual hypertension after successful endovascular treatment of renal artery disease. J Hypertens 2005; 23: 2041–2047.
Tanemoto M, Honkura K, Abe M, Satoh F, Abe T, Ito S : Aldosterone-producing adenoma accompanied with renal artery stenosis. J Nephrol 2006; 19: 540–542.
Honda T, Nakayama T, Saito Y, Ohyama Y, Sumito H, Kurabayashi M : Combined primary aldosteronism and preclinical Cushing's syndrome: an unusual case presentation of adrenal adenoma. Hypertens Res 2001; 24: 723–726.
Makino S, Oda S, Saka T, Yasukawa M, Komatsu F, Sasano H : A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone. Endocrine J 2001; 48: 103–111.
Derks FH, Schalekamp MA : Renal artery stenosis and hypertension. Lancet 1994; 344: 237–239.
Eardley KS, Lipkin GW : Atherosclerotic renal artery stenosis: is it worth diagnosing? J Hum Hypertens 1999; 13: 217–220.
Stowasser M, Gordon RD : Prevalence and diagnostic workup of primary aldosteronism: new knowledge and new approaches. Nephrology 2001; 6: 119–126.
Young WF : Minireview: primary aldosteronism—changing concepts in diagnosis and treatment. Endocrinology 2003; 114: 2208–2213.
Beevers DG, Brown JJ, Ferriss JB, et al: Renal abnormalities and vascular complications in primary hyperaldosteronism. Evidence on tertialy hyperaldosteronism. QJM 1976; 179: 401–410.
Grim C, Weinberger M, Higgins J, Kramer N : Diagnosis of secondary forms of hypertension: a comprehensive protocol. JAMA 1977; 237: 1331–1335.
Kurzman NA, Pillay VK, Rogers PW, Nash D Jr : Renal vascular hypertension and low plasma renin activity. Interrelationship of volume and renin in the pathogenesis of hypertension. Arch Intern Med 1974; 133: 195–199.
Baer L, Sommers SC, Krakoff LR, Newton MA, Laragh JH : Pseudo-primary aldosteronism. An entity distinct from true primary aldosteronism. Circ Res 1970; 27 ( Suppl 1): 203–220.
Conn JW, Cohen EL, Lucas CP, et al: Primary reninism. Arch Intern Med 1972; 130: 682–696.
Tsunoda K, Imai Y, Omata K, et al: Long-term follow-up study of 90 cases of surgically treated aldosterone-producing adenoma. J Jpn Coll Angiol 1993; 33: 149–153.
Suzuki T, Sasano H, Sawai T, et al: Small adrenocortical tumors without clinical apparent clinical endocrine abnormalities. Path Res Prac 1992; 188: 883–889.
Watanabe N, Tsunoda K, Sasano H, et al: Bilateral aldosterone-producing adenoma in two patients diagnosed by immunohistochemical analysis of steroidogenic enzymes. Tohoku J Exp Med 1996; 179: 123–129.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsunoda, K., Abe, K., Yamada, M. et al. A Case of Primary Aldosteronism Associated with Renal Artery Stenosis and Preclinical Cushing's Syndrome. Hypertens Res 31, 1669–1675 (2008). https://doi.org/10.1291/hypres.31.1669
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.31.1669
Keywords
This article is cited by
-
Difficult-to-control hypertension due to bilateral aldosterone-producing adrenocortical microadenomas associated with a cortisol-producing adrenal macroadenoma
Journal of Human Hypertension (2011)
-
Sporadic solitary aldosterone- and cortisol-co-secreting adenomas: endocrine, histological and genetic findings in a subtype of primary aldosteronism
Hypertension Research (2010)