Coexistence of primary aldosteronism and hypercortisolism in patients investigated for secondary hypertension and/or adrenal incidentaloma

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Abstract Objective Primary aldosteronism (PA) accounts for approximately 12% of all hypertension cases and carries significant cardiovascular risk. Hypercortisolism may coexist in patients with PA and has important implications in terms of various comorbidities. This study aimed to investigate the presence of overt Cushing’s syndrome and mild autonomous cortisol secretion (MACS) in patients with PA and to evaluate their clinical impact. Materials and methods Patients who presented to the Endocrinology and Metabolism outpatient clinic of Marmara University Pendik Training and Research Hospital between January 2018 and December 2023 were retrospectively analyzed. Among patients evaluated for secondary hypertension or adrenal mass, 110 patients with an aldosterone-to-renin ratio (ARR) > 20 confirmed by secondary testing, or an ARR > 50 and evaluated for Cushing’s syndrome, were included in the study. Data were analyzed using SPSS version 24. Results The 110 patients with PA were categorized into three groups: those with overt Cushing’s syndrome, those with MACS, and those without hypercortisolism. The prevalence of Cushing’s syndrome and MACS among PA patients was found to be 8.1% and 10%, respectively. Diabetes mellitus was observed in 45% and prediabetes in 35% of patients with coexisting hypercortisolism, whereas these rates were 21.1% and 31.1%, respectively, in those without hypercortisolism ( p = 0.035). The mean HbA1c level was higher in patients with hypercortisolism (5.85%) compared to those without (5.61%) ( p = 0.013). Additionally, serum potassium levels were significantly lower in patients with overt Cushing’s syndrome ( p = 0.032). Conclusion A considerable proportion of patients with primary aldosteronism also exhibit glucocorticoid secretion abnormalities. Both PA and Cushing’s syndrome are endocrine disorders that contribute to hypertension and glycemic disturbances. Diabetes mellitus appears to be more prevalent, and hypokalemia more prominent, in patients with coexisting Cushing’s syndrome. Further prospective studies with larger cohorts are warranted to better characterize the clinical features and outcomes of this patient population.

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