Case 11 - Primary Aldosteronism in a Patient With Bilateral Macronodular Adrenal Hyperplasia and Associated Clinically Important Cortisol Cosecretion

Abstract

Bilateral macronodular adrenal hyperplasia (BMAH) is typically a computed tomography (CT)-based diagnosis. When patients present with primary aldosteronism (PA) and BMAH is found on the CT scan, the aldosterone hypersecretion is bilateral and usually associated with cortisol cosecretion, resulting in either clinically evident Cushing syndrome or subclinical Cushing syndrome (also referred to as “mild autonomous cortisol secretion”). Adrenal venous sampling (AVS) is usually not needed in this setting because, by definition, the disorder is bilateral. Treatment is surgical. If the patient has subclinical Cushing syndrome (mild autonomous cortisol secretion), then there is the opportunity to resect the larger adrenal gland to debulk the disease. If the patient has clinically overt Cushing syndrome, bilateral adrenalectomy is the best treatment option.