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Aldosterone- and cortisol-co-secreting adrenal tumors: an uneasy sum of well-known parts (review)

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Abstract


Primary aldosteronism (PA) is the most common form of secondary arterial hypertension. In patients with PA, more so than in the general population, there is a prevalence of insulin resistance, diabetes mellitus, metabolic syndrome, osteoporosis, and symptoms of depression; these conditions are more likely to manifest a gluco- rather than mineralocorticoid excess. This fact is of particular importance in light of recent studies that have shown that PA is often associated with glucocorticoid excess. Since the first reports of cases of combined secretion of aldosterone and cortisol in 1979, the number of cases of so-called Connshing syndrome has increased. An analysis of data from recent studies suggests that hypercortisolism in PA is closely associated with an increased risk of cardiovascular complications, metabolic disorders and post-surgical adrenal insufficiency. The most important diagnostic problem in adenomas with combined secretion is the risk of false interpretation of the results of adrenal venous sampling (AVS). The indications that suggest aldosterone-and-cortisol-co-producing adenoma are the lack of suppression of cortisol levels following a night test with 1mg of dexamethasone, and an adrenal tumo of over 2.5cm. As an alternative test capable of differentiating this type of tumor, a number of researchers have proposed measuring the level of so-called hybrid steroids in the peripheral plasma and urine. Taking into account the high prevalence and potential risks, ruling out of excess corisol secretion is obligatory in all cases of PA before AVS and when planning surgery.


Boris M. Shifman

Endocrinology Research Centre

Author for correspondence.
Email: boris-11@mail.ru
ORCID iD: 0000-0002-1848-8978
SPIN-code: 5898-2088

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD student

Nadezhda M. Platonova

Endocrinology Research Centre

Email: doc-platonova@inbox.ru
ORCID iD: 0000-0001-6388-1544
SPIN-code: 4053-3033
Scopus Author ID: 9537089700

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Natalya V. Molashenko

Endocrinology Research Centre

Email: molashenko@mail.ru
ORCID iD: 0000-0001-6265-1210
SPIN-code: 5679-2808
Scopus Author ID: 9536569400

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Ekaterina A. Troshina

Endocrinology Research Centre

Email: troshina@inbox.ru
ORCID iD: 0000-0002-8520-8702
SPIN-code: 8821-8990
Scopus Author ID: 24081800800

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD, professor

Natalia Yu. Romanova

Endocrinology Research Centre

Email: oktreotid8@gmail.com
ORCID iD: 0000-0002-9117-4908
SPIN-code: 5288-2968

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Galina S. Kolesnikova

Endocrinology Research Centre

Email: kolesnikova@endocrincentr.ru
ORCID iD: 0000-0002-8698-0681
SPIN-code: 7716-9680
Scopus Author ID: 7005268891

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

PhD

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Supplementary files

Supplementary Files Action
1. Fig. 1. Pathways of steroidogenesis leading to the synthesis of aldosterone, cortisol, and also hybrid steroids: 18-oxo-cortex tizol and 18-hydroxycortisol. CYP11A1 - 20,22-desmolase ("Enzyme that cleaves cholesterol side chain"), HSD3B2 - 3-beta-hydroxysteroid dehydrogenase, type 2, CYP17A1 - 17α-hydroxylase, CYP21A2 - 21-hydroxylase, CYP11B1 - 11β-hydroxylase, CYP11B2 - aldosterone synthase. View (384KB) Indexing metadata

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Copyright (c) 2019 Shifman B.M., Platonova N.M., Molashenko N.V., Troshina E.A., Romanova N.Y., Kolesnikova G.S.

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