Impact of the Cosecretion of Cortisol on Surgical Outcomes and in the Urinary Steroid Profile in Primary Aldosteronism.

OBJECTIVE

To analyze if there are differences in the urinary steroid profile before and after cosyntropin stimulation and in the surgical outcomes between patients with primary aldosteronism (PA) with associated mild autonomous secretion of cortisol (MACS) (MACS-PA) and those without it (only PA).

METHODS

We conducted a prospective, multicenter study of patients consecutively diagnosed with PA in whom a 24-hour urine collection was performed to measure 33 urinary steroid metabolites levels before and after 250 μg intravenous cosyntropin. MACS was defined by the presence of cortisol after a 1 mg-dexamethasone suppression test >1.8 μg/dL and confirmed adrenocorticotropic hormone (ACTH) independency.

RESULTS

Fifty-three patients with PA were included in the study: 15 with MACS-PA and 38 with only PA. Baseline characteristics of both groups were similar, except for higher levels of A1C levels in the first group (P = .034). The baseline urinary steroid profile showed higher levels of β-cortol and β-cortolone in patients with MACS-PA than in those with only PA, and after ACTH stimulation, patients with MACS-PA had a lower increase of glucocorticoids excretion than patients without MACS including α-cortol and 11β-OH-androsterone. Some metabolites even experienced a decrease in their levels after ACTH stimulation (tetrahydrocortisone, α-cortolone, and β-cortolone). Patients with MACS-PA experienced a lower postsurgical decrease in systolic and diastolic blood pressure than in patients with only PA.

CONCLUSION

Patients with MACS-PA exhibited a higher excretion of glucocorticoid metabolites and a lower response to ACTH than patients with PA without associated MACS. Patients with MACS-PA experience a lower quantitative improvement in systolic and diastolic blood pressure after adrenalectomy than patients with only PA.