Oba Kazuhito, Chiba Yuko, Matsuda Yoko, Kumakawa Takeshi, Aoyama Rie, Akahoshi Miho, Hashimoto Seiji, Tachibana Aya, Toyoshima Koichi, Kodera Remi, Toyoshima Kenji, Tamura Yoshiaki, Nagata Takashi, Yamazaki Yuto, Sasano Hironobu, Araki Atsushi
Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, Japan.
Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Case Rep Endocrinol. 2020 Feb 24;2020:2808101. doi: 10.1155/2020/2808101. eCollection 2020.
A 47-year-old woman with a history of diabetes mellitus (DM) and obesity was admitted to our hospital for glucose control. She was detected to have hypertension (HT) and diagnosed with primary aldosteronism (PA) based on the high level of aldosterone to renin ratio and the results of the upright furosemide-loading test according to the criteria of the Japanese Society of Hypertension (JSH) guidelines. Computed tomography revealed left renal tumor and adrenocortical adenoma. She underwent left nephrectomy and adrenalectomy. The pathological findings were clear-cell renal cell carcinoma (RCC) and nonfunctional adrenocortical adenoma. Her nonneoplastic adrenal tissue histologically revealed CYP11B2-positive multiple adrenocortical micronodules (MNs) and concomitant paradoxical hyperplasia of the zona glomerulosa. Therefore, MNs were thought to be responsible for PA in this patient. After surgery, HT was improved, and the result of upright furosemide-loading test after 12 months of surgery did not fulfill the criteria of PA according to the JSH guidelines. However, the adrenocorticotrophic hormone stimulation test was positive; considering the possibility of slight aldosterone overproduction from the right adrenal gland, the administration of spironolactone was started. Herein, we report a rare case of RCC in conjunction with PA histologically associated with MNs.
一名有糖尿病（DM）和肥胖病史的47岁女性因血糖控制问题入住我院。她被检测出患有高血压（HT），并根据日本高血压学会（JSH）指南的标准，基于醛固酮与肾素比值升高以及立位速尿负荷试验结果，被诊断为原发性醛固酮增多症（PA）。计算机断层扫描显示左肾肿瘤和肾上腺皮质腺瘤。她接受了左肾切除术和肾上腺切除术。病理结果为透明细胞肾细胞癌（RCC）和无功能肾上腺皮质腺瘤。她的非肿瘤性肾上腺组织在组织学上显示CYP11B2阳性的多个肾上腺皮质微结节（MNs）以及伴随的球状带反常增生。因此，MNs被认为是该患者PA的病因。手术后，HT得到改善，术后12个月立位速尿负荷试验结果不符合JSH指南中PA的标准。然而，促肾上腺皮质激素刺激试验呈阳性；考虑到右肾上腺可能有轻微醛固酮过度分泌的可能性，开始给予螺内酯治疗。在此，我们报告一例罕见的RCC合并PA且在组织学上与MNs相关的病例。
