Monno Satoshi, Tachikawa Takamitsu, Maekawa Takashi, Sasano Hironobu
Department of Medicine, Chiba-Nishi General Hospital, Matsudo, Japan.
Endocr J. 2015;62(3):283-8. doi: 10.1507/endocrj.EJ14-0552. Epub 2015 Jan 21.
A 39-year-old Japanese woman presented with typical clinical symptoms of Cushing's syndrome, including amenorrhea and hirsutism, for 2 years. The results of her initial endocrine evaluation were consistent with ACTH-independent Cushing's syndrome due to bilateral adrenal masses (diameters of 3.1 cm and 2.4 cm on the left and right, respectively). Serum dehydroepiandrosterone levels were 6,901 ng/mL (normal range 230-2,660 ng/mL). Bilateral laparoscopic adrenalectomies were performed (left adrenalectomy first and right adrenalectomy 3 months later). Following the left adrenalectomy, the results of the endocrine evaluations were still consistent with a diagnosis of ACTH-independent Cushing's syndrome. Serum dehydroepiandrosterone sulphate levels, however, were below the normal range (143 ng/mL). Unexpectedly, the patient's menstruation resumed 2.5 months after the left adrenalectomy. Pathological examination of the resected glands showed bilateral adrenocortical adenomas, one on the left with a diameter of 3 cm, and two on the right with diameters of 0.7 cm and 1.3 cm. Immunohistochemical analysis revealed side chain cleavage, 17α-hydroxylase, 3β-hydroxysteroid dehydrogenase, and 21-hydroxylase immunoreactivity in each adenoma. Dehydroepiandrosterone-sulfotransferase immunoreactivity was pronounced in the left adenoma, less pronounced in one of the right adenoma and weak in the other right adenoma. These results were consistent with clinical endocrine findings. Ours is the first case of a patient with bilateral cortisol-secreting adenomas with unilateral oversecretion of dehydroepiandrosterone sulphate. Resumption of menstruation after the correction of the dehydroepiandrosterone-sulphate excess, despite persistent cortisol excess, indicates the importance of adrenal androgens for the regulation of the menstrual cycle.
一名39岁的日本女性出现库欣综合征的典型临床症状,包括闭经和多毛症,持续2年。其初始内分泌评估结果与双侧肾上腺肿块(左侧直径3.1 cm,右侧直径2.4 cm)导致的非促肾上腺皮质激素(ACTH)依赖性库欣综合征一致。血清脱氢表雄酮水平为6901 ng/mL(正常范围230 - 2660 ng/mL)。进行了双侧腹腔镜肾上腺切除术(先切除左侧肾上腺,3个月后切除右侧肾上腺)。左侧肾上腺切除术后,内分泌评估结果仍与非ACTH依赖性库欣综合征的诊断一致。然而,血清硫酸脱氢表雄酮水平低于正常范围(143 ng/mL)。出乎意料的是,患者在左侧肾上腺切除术后2.5个月月经恢复。切除腺体的病理检查显示双侧肾上腺皮质腺瘤,左侧一个直径3 cm,右侧两个直径分别为0.7 cm和1.3 cm。免疫组织化学分析显示每个腺瘤中均有侧链裂解酶、17α - 羟化酶、3β - 羟类固醇脱氢酶和21 - 羟化酶免疫反应性。硫酸脱氢表雄酮硫酸转移酶免疫反应性在左侧腺瘤中明显,在右侧一个腺瘤中较不明显,在另一个右侧腺瘤中较弱。这些结果与临床内分泌发现一致。我们报道的是首例双侧分泌皮质醇腺瘤且单侧硫酸脱氢表雄酮分泌过多的病例。尽管皮质醇持续过量,但在纠正硫酸脱氢表雄酮过量后月经恢复,这表明肾上腺雄激素对月经周期调节的重要性。