A 45-year-old woman comes to the office due to a 4-month history of headaches and blurred vision. She takes no medications and has no other medical problems. After the initial laboratory workup, an abdominal CT is performed that shows a 2-cm left-sided adrenal mass. The patient undergoes an uncomplicated left-sided adrenalectomy. Gross examination of the adrenal gland demonstrates a well-defined yellowish tumor within the cortex. Assuming the tumor cells are functionally similar to cells from the outermost layer of the adrenal cortex, this patient would most likely have presented with which of the following additional symptoms?

Question

A 45-year-old woman comes to the office due to a 4-month history of headaches and blurred vision.  She takes no medications and has no other medical problems.  After the initial laboratory workup, an abdominal CT is performed that shows a 2-cm left-sided adrenal mass.  The patient undergoes an uncomplicated left-sided adrenalectomy.  Gross examination of the adrenal gland demonstrates a well-defined yellowish tumor within the cortex.  Assuming the tumor cells are functionally similar to cells from the outermost layer of the adrenal cortex, this patient would most likely have presented with which of the following additional symptoms?

Quizplus · Accepted Answer

11ec160b_3ab8_985c_9249_bb295865bbe3_MD0001_00 Presumably, this patient had symptoms of primary hyperaldosteronism due to an aldosterone-producing adenoma (Conn syndrome). Adrenocortical adenomas appear as well-defined yellowish tumors of the adrenal cortex on gross examination, regardless of functional status. This tumor is functionally similar to the outermost layer of the adrenal cortex, which normally produces aldosterone. Aldosterone acts on renal cortical collecting ducts to facilitate the exchange of Na⁺ for K⁺ and H⁺ in the tubular fluid. As a result, excess production of aldosterone causes renal Na⁺ retention and excess urinary K⁺ and H⁺ secretion, resulting in hypertension, hypokalemia, and metabolic alkalosis. These electrolyte abnormalities can cause paresthesias and muscle weakness in some patients with primary hyperaldosteronism. Significant extracellular fluid volume expansion does not occur in primary hyperaldosteronism due to aldosterone escape. (Choice A) Diarrhea and flushing may be seen in carcinoid syndrome, a rare condition most often caused by a serotonin (5-HT)-secreting tumor derived from neuroendocrine cells of the gastrointestinal tract. (Choice B) Excessive hair growth (hirsutism) can result from excess androgen production. An adrenal tumor causing androgen hypersecretion would have the functionality of the third (innermost) layer of the adrenal cortex, the zona reticularis. (Choice D) Sweating and tremulousness can be caused by excess circulating catecholamines, which may result from a pheochromocytoma. These tumors arise from the adrenal medulla rather than the adrenal cortex. (Choice E) Patients with Cushing syndrome often develop weight gain due to central fat accumulation, along with easy bruising and weakening of the skin and subcutaneous connective tissue. Cortisol-secreting adrenal lesions would be functionally similar to the middle layer of the adrenal cortex (zona fasciculata). Educational objective: Hypersecreting adrenocortical tumors can have functionality resembling the outer (aldosterone/Conn syndrome), middle (cortisol/Cushing syndrome), or inner (androgens/hirsutism and virilization) layers of the adrenal cortex. __________ References: Diagnosis and management of primary aldosteronism: an updated review. (http://www.ncbi.nlm.nih.gov/pubmed/23701121)

A 45-Year-Old Woman Comes to the Office Due to a 4-Month