Laparoscopic adrenalectomy for co-secreting aldosterone and cortisol adenomas

Abstract

There are few published data on aldosterone and cortisol co-secreting adrenal tumours. Failure to perform comprehensive preoperative endocrine investigations in patients with adrenal "incidentalomas" or in those thought to be secreting only one hormone may account for this. Clinically patients with such lesions may have evidence of hypertension and hypokalaemia with no features of cortisol excess. Preoperative diagnosis of such lesions with accurate endocrinological work up is essential to prevent adrenal insufficiency and haemodynamic crises following removal of such glands. We present a series of 4 patients with co-secreting tumours treated by laparoscopic adrenalectomy between September 2010 and March 2011. Our experience suggests that dual secretors are more common than originally thought. A high index of suspicion and adequate endocrine work up is paramount in diagnosing such tumours and in experienced hands, laparoscopic adrenalectomy with appropriate substitutive steroid cover is safe, feasible and curative for these functioning adrenal tumours.

Clinical characteristics of PRKACA mutations in Chinese patients with adrenal lesions: a single‐centre study

“…Our results suggest that aldosterone and cortisol co‐secreting adenomas are not rare and more likely to be clinically diagnosed as aldosterone‐producing adenoma. Previous reports came to a similar conclusion . All of the eight patients underwent retroperitoneal laparoscopic adrenalectomy or partial adrenalectomy, and they recovered uneventfully after surgery.…”

“…Previous reports came to a similar conclusion. [26][27][28] All of the eight patients underwent retroperitoneal laparoscopic adrenalectomy or partial adrenalectomy, and they recovered uneventfully after surgery. A study suggested that preoperative diagnosis of such lesions is beneficial to patients, making an impact on therapy and postoperative management.…”

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

“…Also, aldosterone has a shorter half-life (20 min) than cortisol (60–70 min) that may interfere in the interpretation of AVS findings. Furthermore, aldosterone and cortisol co-producing adenomas may be more common than previously thought [32], making interpretation of both successfulness as well as laterality difficult. In fact, one patient (Subject 6) in our cohort had a strikingly high aldosterone concentration from the left adrenal vein, due to a concomitant primary aldosteronism.…”