Teragawa Hiroki, Oshita Chikage, Orita Yuichi, Hashimoto Kunihiro, Nakayama Hirofumi, Yamazaki Yuto, Sasano Hironobu
Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan.
Department of Urology, JR Hiroshima Hospital, Hiroshima 732-0057, Japan.
World J Clin Cases. 2021 Feb 16;9(5):1119-1126. doi: 10.12998/wjcc.v9.i5.1119.
Adrenal incidentaloma (AI) has been frequently encountered in the clinical setting. It has been shown that primary aldosteronism (PA) or subclinical Cushing's syndrome (SCS) are the representative causative diseases of AI. However, the coexistence of PA and SCS has been reportedly observed. Recently, we encountered a case of AI, in which PA and SCS coexisted, confirmed by histopathological examinations after a laparoscopic adrenalectomy. We believe that there were some clinical implications in the diagnosis of the present case.
A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg. A subsequent computed tomography scan revealed right ureterolithiasis, which was the cause of right abdominal pain, and right AI measuring 22 mm × 25 mm. After the disappearance of right abdominal pain, subsequent endocrinological examinations were performed. Aldosterone-related evaluations, including adrenal venous sampling, revealed the presence of bilateral PA. In addition, several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma. A laparoscopic right adrenalectomy was then performed. The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma, while CYP11B2 immunoreactivity was absent in this adenoma. However, in the adjacent non-neoplastic adrenal, multiple CYP11B2-positive adrenocortical micronodules were detected, showing the presence of aldosterone-producing adrenocortical micronodules.
Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.
肾上腺偶发瘤（AI）在临床中较为常见。研究表明，原发性醛固酮增多症（PA）或亚临床库欣综合征（SCS）是AI的典型致病疾病。然而，据报道PA和SCS可同时存在。最近，我们遇到一例AI患者，经腹腔镜肾上腺切除术后组织病理学检查证实PA和SCS并存。我们认为该病例的诊断具有一定临床意义。
一名58岁男性因右下腹痛就诊，血压为170/100 mmHg。随后的计算机断层扫描显示右输尿管结石，这是右下腹痛的原因，同时发现右侧有一个22 mm×25 mm的AI。右下腹痛消失后，进行了后续内分泌检查。包括肾上腺静脉采血在内的醛固酮相关评估显示双侧PA存在。此外，多项皮质醇相关评估显示右侧肾上腺腺瘤存在SCS。随后进行了腹腔镜右肾上腺切除术。切除的右肾上腺组织病理学检查显示存在产生皮质醇的腺瘤，而该腺瘤中CYP11B2免疫反应阴性。然而，在相邻的非肿瘤性肾上腺组织中，检测到多个CYP11B2阳性的肾上腺皮质微结节，表明存在产生醛固酮的肾上腺皮质微结节。
当患有AI的患者同时出现SCS和PA时，应进行仔细的临床和病理检查。
