Bilateral macro nodular adrenal hyperplasia causing primary hyperaldosteronism and Cushing syndrome

The coexistence of primary hyperaldosteronism and Cushing's syndrome in the same patient is an uncommon situation.
We report the case of a 35-year-old female patient with resistant hypertension since the age of 30 years in whom exploration revealed a combination of primary hyperaldosteronism and ACTH-independent Cushing syndrome in the context of bilateral macro nodular adrenal hyperplasia.
G protein-coupled receptors aberrantly expressed in the adrenal cortex appear to have a central role in hormone hypersecretion and cell proliferation in this disease. However, other molecular mechanisms - such as mutations in Gsp or ACTH receptors, and adrenal paracrine hormone secretion may also be involved in this disease.
A good understanding of this rare and heterogeneous disease entity has contributed to a more accurate assessment of patients with PBMAH, improving earlier diagnosis and offering new therapeutic and potentially preventive strategies.