Keywords
Aldosterone
Renin
Case Reports
Cysts
Hypertension
How to Cite
Abstract
Background: Adrenal cysts are uncommon, being even more scarce functional cysts with 3 cases reported in the literature
Purpose: To present a clinical case of a patient with hyperaldosteronism associated with an adrenal cyst.
Case presentation: A 39-year-old male patient with hypertension since the age of 38. It was decided to perform studies of secondary hypertension, with a positive finding of primary hyperaldosteronism in initial evaluation. Biochemical confirmation was performed with a solution suppression test with subsequent discovery of low-density left adrenal adenoma on an abdomen contrasted CT scan. The patient underwent laparoscopic adrenalectomy, achieving biochemical cure according to the evaluation conducted 4 months postoperatively, without the need for antihypertensive medication.
Discussion and conclusion: Adrenal cysts usually present unilaterally with different histopathological categories, and are usually nonfunctional. Primary hyperaldosteronism is a common cause of secondary hypertension and may be associated with cardiovascular complications. Diagnosis is based on measurement of aldosterone and renin in blood and biochemical confirmation, with subsequent localization evaluation including adrenal vein catheterization, in most cases, to determine the underlying cause.
Our patient is the 4th case published in the literature on a cyst with biochemically confirmed hormonal overproduction, which is important not to rule out the presence of cysts as a possible etiology of hormone production that, although it is not the most common, it is possible to find them.
References
Song JH, Chaudhry FS, Mayo-Smith WW. The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1,049 Consecutive Adrenal Masses in Patients with No Known Malignancy. Am J Roentgenol. 2008;190(5):1163-8. https://doi.org/10.2214/AJR.07.2799
Goel D, Enny L, Rana C, Ramakant P, Singh K, Babu S, et al. Cystic adrenal lesions: A report of five cases. Cancer Rep. 2021;4(1). https://doi.org/10.1002/cnr2.1314
Adam A, Dixon AK, Gillard JH, Schaefer-Prokop C. Grainger & Allison’s diagnostic radiology: a textbook of medical imaging. Londres: Churchill Livingstone; 2021.
Sakaue T, Okuno Y, Mukai K, Fujita S, Kozawa J, Nishizawa H, et al. Coincidence of Large Adrenal Cyst and Prominent Hyporeninemic Hyperaldosteronism. Case Rep Endocrinol. 2021:1-6. https://doi.org/10.1155/2021/8860498
Cavallaro G, Crocetti D, Paliotta A, De Gori A, Tarallo MR, Letizia C, et al. Cystic adrenal lesions: Clinical and surgical management. The experience of a referral centre. Int J Surg. 2015;13:23-6. https://doi.org/10.1016/j.ijsu.2014.11.023
Clements HA, Wilson MS, Smith DM. Incidental giant cystic pheochromocytoma: a case report and review of the literature. Scott Med J. 2020;65(2):64-70. https://doi.org/10.1177/0036933019900339
Escudero MD, Sabater L, Calvete J, Camps B, Labiós M, Lledó S. Arterial hypertension due to primary adrenal hydatid cyst. Surgery. 2002;132(5):894-5. https://doi.org/10.1067/msy.2002.119313
Safioleas MC, Moulakakis KG, Manti C, Kostakis A. Coexistence of Primary Adrenal Hydatid Cyst and Arterial Hypertension: Report of a case and review of the literature. Acta Chir Belg. 2006;106(6):719-21. https://doi.org/10.1080/00015458.2006.11679992
Geramizadeh B, Ziyaian B, Maghbou M. Primary Hydatid Cyst of the Adrenal Gland: A Case Report and Review of the Literature. Iran Red Crescent Med J. 2011;13(5).
Horchani A, Nouira Y, Nouira K, Bedioui H, Menif E, Safta ZB. Hydatid Cyst of the Adrenal Gland: A Clinical Study of Six Cases. Sci World J. 2006;6:2420-5. https://doi.org/10.1100/tsw.2006.375
Erbil Y, Salmasl?o?lu A, Barbaros U, Bozbora A, Mete Ö, Aral F, et al. Clinical and Radiological Features of Adrenal Cysts. Urol Int. 2008;80(1):31-6. https://doi.org/10.1159/000111726
Ricci Z, Chernyak V, Hsu K, Mazzariol FS, Flusberg M, Oh S, et al. Adrenal Cysts: Natural History by Long-Term Imaging Follow-Up. Am J Roentgenol. 2013;201(5):1009-16. https://doi.org/10.2214/AJR.12.9202
Bennett JE, Dolin R, Blaser MJ. Enfermedades infecciosas: principios y práctica. Barcelona: Elsevier; 2020.
Di Cataldo A, Trombatore G, Greco R, Lanteri R, Li Destri G, Licata A. Hydatid disease in a very unusual location: the adrenal gland. A case report. Chir Ital. 2003;55(2):275-8.
Bosnal? O, Moralio?lu S, Celayir A. Adrenal Cystic Lymphangioma. West Indian Med J. 2014;64(3):311-2. https://doi.org/10.7727/wimj.2014.116
Foster DG. Adrenal Cysts: Review of Literature and Report of Case. Arch Surg. 1966;92(1):131. https://doi.org/10.1001/archsurg.1966.01320190133032
Käyser SC, Dekkers T, Groenewoud HJ, van der Wilt GJ, Carel Bakx J, van der Wel MC, et al. Study Heterogeneity and Estimation of Prevalence of Primary Aldosteronism: A Systematic Review and Meta-Regression Analysis. J Clin Endocrinol Metab. 2016;101(7):2826-35. https://doi.org/10.1210/jc.2016-1472
Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet. 2008;371(9628):1921-6. https://doi.org/10.1016/S0140-6736(08)60834-X
Mehdi A, Rao P, Thomas G. Our evolving understanding of primary aldosteronism. Clevel Clin J Med. 2021;88(4):221-7. https://doi.org/10.3949/ccjm.88a.20166
Lim JS, Park S, Park SI, Oh YT, Choi E, Kim JY, et al. Cardiac Dysfunction in Association with Increased Inflammatory Markers in Primary Aldosteronism. Endocrinol Metab. 2016;31(4):567. https://doi.org/10.3803/EnM.2016.31.4.567
Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243-8. https://doi.org/10.1016/j.jacc.2005.01.015
Tsai CH, Chen YL, Pan CT, Lin YT, Lee PC, Chiu YW, et al. New-Onset Atrial Fibrillation in Patients With Primary Aldosteronism Receiving Different Treatment Strategies: Systematic Review and Pooled Analysis of Three Studies. Front Endocrinol. 2021;12:646933. https://doi.org/10.3389/fendo.2021.646933
Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916. https://doi.org/10.1210/jc.2015-4061
Reincke M, Bancos I, Mulatero P, Scholl UI, Stowasser M, Williams TA. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021;9(12):876-92. https://doi.org/10.1016/S2213-8587(21)00210-2
Rossi GP. Update in adrenal venous sampling for primary aldosteronism. Curr Opin Endocrinol Diabetes Obes. 2018;25(3):160-71. https://doi.org/10.1097/MED.0000000000000407
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