cosyntropin and Hyperkalemia

We describe a case of a 42 year old male who presented with Addison's disease resulting from primary lymphoma of the adrenals. Our case and a review of the literature indicates that this distinct entity has some unique clinical and radiologic features. In this entity, the lymphoma tends to be extranodal and have a poor prognosis. In addition, the computed tomography (CT) images have the unique appearance of enlargement of the adrenal gland with maintenance of the adreniform shape. We suggest that primary adrenal lymphoma is a distinct clinical entity and should be considered in patients with an elevated serum lactate dehydrogenase, characteristic CT findings and Addison's disease.

Topics: Addison Disease; Adrenal Cortex Neoplasms; Adrenal Gland Diseases; Adult; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cosyntropin; Cyclophosphamide; Dexamethasone; Diagnosis, Differential; Doxorubicin; Etoposide; Eye Neoplasms; Fatal Outcome; Humans; Hydrocortisone; Hyperkalemia; Ifosfamide; L-Lactate Dehydrogenase; Lymphoma, T-Cell; Male; Methotrexate; Neoplasm Proteins; Oculomotor Muscles; Prednisone; Tomography, X-Ray Computed; Tuberculosis, Endocrine; Vincristine

A published clinical prediction score indicated that a unilateral adrenal adenoma and either hypokalemia or an estimated glomerular filtration rate of 100 ml/min/1.73 m2 was 100% specific for unilateral primary aldosteronism. This study aimed to validate this score in a separate cohort of patients with primary aldosteronism.. A review of patients with primary aldosteronism from June 2005 to July 2013 at a single center's hypertension clinic. One hundred twelve patients with primary aldosteronism underwent successful adrenal vein sampling and the 110 patients with full data available were included in the final analysis. Adrenal vein sampling was performed all patients desiring surgery by the simultaneous collection of sample prior to and 15 minutes after a cosyntropin infusion with a 3:1 aldosterone/cortisol ratio diagnosing unilateral primary aldosteronism. The derived score was applied to the cohort. Sensitivity and specificity were calculated for clinical prediction score of ≥5 points.. There were 64 patients found to have unilateral primary aldosteronism and 48 had bilateral disease. A score ≥5 points had 64% sensitivity (95% confidence interval, 51-76) and 85% specificity (95% confidence interval, 71-94) for unilateral disease. Four patients had lateralization of primary aldosteronism to the side contralateral to the adenoma.. The 100% specificity of the score for the unilateral origin of primary aldosteronism was not validated in this cohort with a score of ≥5 points. At best, a high score in this prediction rule may be an additional tool for helping to confirm a decision to offer patients adrenal vein sampling.

Topics: Adrenal Glands; Adult; Aldosterone; Cosyntropin; Female; Glomerular Filtration Rate; Humans; Hydrocortisone; Hyperaldosteronism; Hyperkalemia; Male; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Veins

Two infants developed hyperkalemia shortly after cessation of prolonged ACTH therapy for infantile spasms. We wish to call for cautious approach at time of cessation of prolonged ACTH therapy because of possible unexpected and only partially understood hazardous side effects such as hyperkalemia.

Topics: Cosyntropin; Electroencephalography; Female; Humans; Hyperkalemia; Infant; Long-Term Care; Male; Spasms, Infantile