MON-200 Clinical Characterizations of Aldosterone- and Cortisol-Producing Adrenal Tumors in Primary Aldosteronism

Objective: Aldosterone- and cortisol-producing adrenal tumors (A/CPTs) are considered to be a subtype of primary aldosteronism (PA). The clinical characterizations of these tumors are still unclear, and they are often neglected by clinicians. The aim of this study was to summarize the clinical characterizations of these tumors to reduce the missed diagnosis. Methods: The clinical, imaging and pathological data of patients with PA admitted to our hospital from January 1, 2013 to December 31, 2016 was reviewed. All the PA patients with a combination of a positive aldosterone-to-renin ratio (ARR) and a positive captopril challenge test (CCT), in whom the dexamethasone inhibition test was performed as well, were included in our study. These patients were divided into two groups, A/CPTs group and simple PA group, according to the function of cortisol secretion. The data of the two groups were compared and analyzed with SPSS 23.0. P<0.05 was statistically significant. Results: There were 87 patients with PA included in our study, 32 of whom (36.8%) were diagnosed with A/CPTs. In these 32 A/CPTs patients, 31 patients (96.9%) were combined with subclinical Cushing syndrome. Compared to these in simple PA group (n=55), the patients in A/CPTs group (n=32) were elder (53.81±10.70 ys vs 48.42±10.17 ys, P=0.022), with larger diameter of adrenal tumors (1.50cm vs 1.15cm, P=0.001), higher fasting plasma glucose (5.33mmo/L vs 4.99mmol/L, P=0.047), higher serum cortisol levels and lower serum ACTH levels (all P<0.05). 24 patients in A/CPTs group and 23 patients in simple PA group underwent adrenalectomy. 6 patients (25.0%) in A/CPTs group and 3 patients (13.0%) in simple PA group received glucocorticoid replacement therapy after adrenalectomy. Conclusions:The prevalence of A/CPTs in PA is high. The patients with A/CPTs are mainly combined with subclinical Cushing syndrome, and prone to need glucocorticoid replacement therapy. Therefore, we recommend that all patients with PA should evaluate the function of cortisol secretion, and all patients with A/CPTs should be followed up closely after adrenalectomy to reduce the morbidity of adrenal insufficiency.