Shigematsu Kazuto, Nishida Noriyuki, Sakai Hideki, Igawa Tsukasa, Suzuki Shin, Kawai Kioko, Takahara Osamu
Department of Pathology, Japanese Red-Cross Nagasaki Atomic Bomb Hospital, Nagasaki, 852-8511, Japan.
Endocr Pathol. 2009 Spring;20(1):66-72. doi: 10.1007/s12022-009-9060-8.
Aldosterone-producing adenoma (APA) consisting of pure zona glomerulosa (ZG)-type cells is extremely rare, and primary aldosteronism complicated by pregnancy is also rare. We report a case of APA discovered in a 32-year-old pregnant woman who visited our hospital for hypertension and hypokalemia at 26 weeks gestation. Elevated plasma aldosterone concentration and hypokalemia were observed, and an magnetic resonance imaging scan demonstrated a right adrenal mass. A laparoscopic adrenalectomy was performed because of refractory hypokalemia. Pathologically, the adrenal mass was diagnosed as APA, and in addition to the cytological features, in situ hybridization and real-time polymerase chain reaction proved that all the component cells were ZG-type cells. The cells also showed estrogen receptor beta immunoreactivity and melanocortin 2 receptor mRNA expression, suggesting that estrogen and/or ACTH might be related to the proliferation of APA cells during pregnancy. Our case is the first report of APA consisting of ZG-type cells discovered during pregnancy.
由纯球状带（ZG）型细胞组成的醛固酮瘤（APA）极为罕见，而原发性醛固酮增多症合并妊娠也很罕见。我们报告一例在孕26周时因高血压和低钾血症前来我院就诊的32岁孕妇中发现的APA病例。观察到血浆醛固酮浓度升高和低钾血症，磁共振成像扫描显示右肾上腺肿块。由于难治性低钾血症，进行了腹腔镜肾上腺切除术。病理上，肾上腺肿块被诊断为APA，除细胞学特征外，原位杂交和实时聚合酶链反应证明所有组成细胞均为ZG型细胞。这些细胞还显示雌激素受体β免疫反应性和黑皮质素2受体mRNA表达，提示雌激素和/或促肾上腺皮质激素可能与妊娠期APA细胞的增殖有关。我们的病例是妊娠期间发现的由ZG型细胞组成的APA的首例报告。
