Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital.
Department of Diagnostic Radiology, Tohoku University Hospital.
Tohoku J Exp Med. 2021 Feb;253(2):143-150. doi: 10.1620/tjem.253.143.
Although adrenal resection is a major option to control hypercortisolemia in patients with bilateral macronodular adrenal hyperplasia, a predictive method for postoperative cortisol production has not been established. A 53-year-old man with ulcerative colitis was referred to our hospital for bilateral multiple adrenal nodules and hypertension. Physical and endocrinological examination revealed inappropriate cortisol production and suppressed secretion of adrenocorticotropic hormone with no typical signs of Cushing's syndrome. Imaging analysis revealed bilateral adrenal nodular enlargement, the nodules of which had the radiological features of adrenocortical adenomas without inter-nodular heterogeneity. In addition, computed tomography volumetry demonstrated that the left adrenal gland (70 mL) accounts for three quarters of the total adrenal volume (93 mL). The patient was diagnosed as subclinical Cushing's syndrome due to bilateral macronodular adrenal hyperplasia, and subsequently underwent a left laparoscopic adrenalectomy with the estimation of 75% decrease in the cortisol level based on the adrenal volume. The surgical treatment ultimately resulted in control of the cortisol level within the normal range, which was compatible to our preoperative prediction. However, regardless of the sufficient cortisol level, ulcerative colitis was exacerbated after the surgery, which needed a systemic therapy for remission. This case indicates successful surgical control of hypercortisolemia based on computed tomography volumetry in bilateral macronodular adrenal hyperplasia, as well as the perioperative exacerbation risk for inflammatory diseases in Cushing's syndrome. We report the potential utility of computed tomography volumetry as a quantitative method with retrospective evaluation of our historical cases.
尽管肾上腺切除术是控制双侧大结节性肾上腺增生患者皮质醇过多的主要选择，但尚未建立预测术后皮质醇生成的方法。一名 53 岁男性患有溃疡性结肠炎，因双侧多发肾上腺结节和高血压被转诊至我院。体格检查和内分泌检查显示皮质醇产生不当，促肾上腺皮质激素分泌受到抑制，无库欣综合征的典型表现。影像学分析显示双侧肾上腺结节性增大，结节具有肾上腺皮质腺瘤的放射学特征，无结节间异质性。此外，计算机断层扫描体积测量显示左肾上腺（70ml）占总肾上腺体积（93ml）的四分之三。该患者被诊断为双侧大结节性肾上腺增生所致亚临床库欣综合征，随后接受了腹腔镜左侧肾上腺切除术，根据肾上腺体积估计皮质醇水平降低 75%。手术治疗最终使皮质醇水平控制在正常范围内，与我们的术前预测相符。然而，尽管皮质醇水平充足，但手术后溃疡性结肠炎仍加重，需要全身性治疗以缓解。该病例表明，基于双侧大结节性肾上腺增生的计算机断层扫描体积测量，可以成功控制皮质醇过多，并且库欣综合征中炎症性疾病存在围手术期加重的风险。我们报告了计算机断层扫描体积测量作为一种定量方法的潜在用途，并对我们的历史病例进行了回顾性评估。
