Adrenocortical hypofunction with simultaneous primary aldosteronism: A case report

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Primary aldosteronism typically involves adrenal hyperfunction, often due to tumors or adenomas secreting excess aldosterone.
• Adrenocortical hypofunction coexisting with primary aldosteronism has not been previously reported in medical literature.

Observation:

• A 66-year-old woman with a history of secondary adrenal insufficiency, rheumatoid arthritis, and type 2 diabetes presented with symptoms suggestive of adrenal dysfunction.
• Diagnostic tests, including imaging and hormonal assays, revealed bilateral adrenal hyperplasia, elevated aldosterone levels, and a high aldosterone-to-renin ratio (ARR), confirming primary aldosteronism.
• Despite the diagnosis of primary aldosteronism, the patient exhibited signs of adrenocortical hypofunction, indicated by cortisol dysfunction and the need for glucocorticoid replacement therapy.

Findings:

• The patient was diagnosed with the rare condition of adrenocortical hypofunction combined with primary aldosteronism.
• Treatment with spironolactone and continued glucocorticoid replacement therapy helped maintain normal blood pressure.
• Hormonal monitoring post-treatment showed persistent high aldosterone levels and ARR, consistent with primary aldosteronism.

Implications:

• This case underscores the complexity of adrenal disorders and the possibility of coexisting, seemingly contradictory conditions.
• It emphasizes the critical need for comprehensive hormonal evaluation, including both aldosterone and cortisol levels, in patients presenting with adrenal dysfunction.
• Further research may be warranted to understand the underlying mechanisms of this rare combined endocrine disorder.