Case Reports
Secondary hyperaldosteronism leading to resistant hypertension in a patient with adrenal Cushing’s syndrome
Authors:
I. Ranathunga ,
National Hospital of Sri Lanka, LK
About I.
Diabetes and Endocrinology unit
N. P. Somasundaram
National Hospital of Sri Lanka, LK
About N. P.
Diabetes and Endocrinology unit
Abstract
Background
Cushing’s syndrome (CS) is a rare disorder caused by prolonged hypercortisolism leading to increased morbidity and mortality. Hypertension in Cushing’s syndrome could be caused by multiple mechanism including primary hyperaldosteronism from co-secretion of aldosterone from the adrenal tumour, and rarely due to secondary hyperaldosteronism.
Case presentation
A-36-year old female with poorly controlled hypertension, dyslipidaemia and diabetes mellitus presented with progressive truncal obesity with marked abdominal distension. She also had proximal muscle weakness and oligomenorrhea. On examination, specific clinical features suggestive of Cushing’s syndrome such as round face, facial plethora, truncal obesity with fat distribution in the face, neck, trunk, abdomen with sparing of the limbs, thin skin and proximal myopathy were present. Investigations confirmed the diagnosis of adrenocorticotrophic hormone independent adrenal Cushing’s syndrome due to a left adrenal adenoma with secondary hyperaldosteronism. Subsequently, she underwent laparoscopic left adrenalectomy as the definitive management which resulted in good clinical outcome.
Conclusions
Secondary hyperaldosteronism can be a rare association of Cushing’s syndrome and can contribute to resistant hypertension. Possible pathogenesis comprises of renin co-secretion, increased vascular responsiveness to vasopressor agents, increased renin levels leading to increased angiotensin 1 formation and possible interference of aldosterone action by steroids. Successful treatment of the primary pathology results in cure of the abnormality.
How to Cite:
Ranathunga, I. and Somasundaram, N.P., 2020. Secondary hyperaldosteronism leading to resistant hypertension in a patient with adrenal Cushing’s syndrome. Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 10(2), pp.37–42. DOI: http://doi.org/10.4038/sjdem.v10i2.7422
Published on
25 Aug 2020.
Peer Reviewed
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