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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Endocrinol+Metab
2016 ; 101
(11
): 4290-4297
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A Novel Phenotype of Familial Hyperaldosteronism Type III: Concurrence of
Aldosteronism and Cushing s Syndrome
#MMPMID27403928
Tong A
; Liu G
; Wang F
; Jiang J
; Yan Z
; Zhang D
; Zhang Y
; Cai J
J Clin Endocrinol Metab
2016[Nov]; 101
(11
): 4290-4297
PMID27403928
show ga
CONTEXT: To date, all the familial hyperaldosteronism type III (FH-III) patients
reported presenting with typical primary aldosteronism (PA), without showing
other adrenal hormone abnormalities. OBJECTIVE: This study characterized a novel
phenotype of FH-III and explored the possible pathogenesis. PATIENTS AND METHODS:
A male patient presented with severe hypertension and hypokalemia at the age of 2
years and developed Cushing's syndrome at 20 years. He was diagnosed with PA and
Cushing's syndrome on the basis of typical biochemical findings. He had massive
bilateral adrenal hyperplasia and underwent left adrenalectomy. KCNJ5 was
sequenced, and secretion of aldosterone and cortisol were observed both in vivo
and in vitro. RESULTS: A heterozygous germline p.Glu145Gln mutation of KCNJ5 was
identified. ARMC5, PRKAR1A, PDE8B, PDE11A, and PRKACA genes and ?-catenin, P53
immunoactivity were normal in the adrenal. CYP11B2 was highly expressed, whereas
mRNA expression of CYP11B1, CYP17A1, and STAR was relatively low in the
hyperplastic adrenal, compared with normal adrenal cortex and other adrenal
diseases. In the primary cell culture of the resected hyperplastic adrenal,
verapamil and nifedipine, two calcium channel blockers, markedly inhibited the
secretion of both aldosterone and cortisol and the mRNA expression of CYP11B1,
CYP11B2, CYP17A1, and STAR. CONCLUSIONS: We presented the first FH-III patient
who had both severe PA and Cushing's syndrome. Hypersecretion of cortisol might
be ascribed to overly large size of the hyperplastic adrenal because CYP11B1
expression was relatively low in his adrenal. Like aldosterone, synthesis and
secretion of cortisol in the mutant adrenal may be mediated by voltage-gated
Ca(2+) channels.