The Silent Second Hormone Hiding in 1 in 4 Aldosteronism Patients

Key Takeaway

Primary aldosteronism is often more than a one-hormone disease. About 1 in 4 patients also secretes cortisol autonomously, and this pairing is linked to higher odds of cardiovascular events and type 2 diabetes. An inexpensive overnight dexamethasone test belongs in every aldosteronism workup.

The Second Hormone Nobody Measured

Consider a composite patient many of us have met. She is 54, with hypertension that resists 3 drugs, a low potassium level, and suppressed renin. A CT scan shows a 2-cm left adrenal nodule. Adrenal vein sampling confirms the left gland as the source of aldosterone, and adrenalectomy goes smoothly. Her fasting glucose had been creeping upward, and everyone blamed age. No one checked her cortisol. Four days after surgery she returns with vomiting, crushing fatigue, and a blood pressure of 82/50. Her remaining adrenal gland had been quietly suppressed for years and could not keep up.…