Secondary hyperaldosteronism leading to resistant hypertension in a patient with adrenal Cushing’s syndrome

Background

Cushing’s syndrome (CS) is a rare disorder caused by prolonged hypercortisolism leading to increased morbidity and mortality. Hypertension in Cushing’s syndrome could be caused by multiple mechanism including primary hyperaldosteronism from co-secretion of aldosterone from the adrenal tumour, and rarely due to secondary hyperaldosteronism.

 

Case presentation

A-36-year old female with poorly controlled hypertension, dyslipidaemia and diabetes mellitus presented with progressive truncal obesity with marked abdominal distension. She also had proximal muscle weakness and oligomenorrhea. On examination, specific clinical features suggestive of Cushing’s syndrome such as round face, facial plethora, truncal obesity with fat distribution in the face, neck, trunk, abdomen with sparing of the limbs, thin skin and proximal myopathy were present. Investigations confirmed the diagnosis of adrenocorticotrophic hormone independent adrenal Cushing’s syndrome due to a left adrenal adenoma with secondary hyperaldosteronism. Subsequently, she underwent laparoscopic left adrenalectomy as the definitive management which resulted in good clinical outcome.

 

Conclusions

Secondary hyperaldosteronism can be a rare association of Cushing’s syndrome and can contribute to resistant hypertension. Possible pathogenesis comprises of renin co-secretion, increased vascular responsiveness to vasopressor agents, increased renin levels leading to increased angiotensin 1 formation and possible interference of aldosterone action by steroids. Successful treatment of the primary pathology results in cure of the abnormality.