Department of Medicine, Shiga University of Medical Science, Japan.
Department of Urology, Shiga University of Medical Science, Japan.
Intern Med. 2023 Sep 15;62(18):2685-2691. doi: 10.2169/internalmedicine.1012-22. Epub 2023 Feb 1.
A 46-year-old woman was referred for hypertension and a right adrenal tumor. Primary aldosteronism (PA) was suspected because of the high plasma aldosterone concentration-to-plasma renin activity ratio. However, a subsequent evaluation revealed coexistent PA and pheochromocytoma. We performed laparoscopic right adrenalectomy. Histology of the resected adrenal gland confirmed pheochromocytoma and multiple aldosterone-producing adrenocortical micronodules. Following adrenalectomy, the urinary catecholamine levels normalized, and hyperaldosteronism improved but persisted. Hypertension also improved but persisted and was normalized with spironolactone. The clinical course indicated that the PA lesions were likely bilateral. This was a histologically proven case of coexistent pheochromocytoma and PA due to multiple aldosterone-producing micronodules.
一位 46 岁女性因高血压和右肾上腺肿瘤就诊。由于血浆醛固酮浓度与血浆肾素活性比值高，怀疑为原发性醛固酮增多症（PA）。然而，随后的评估显示同时存在 PA 和嗜铬细胞瘤。我们进行了腹腔镜右肾上腺切除术。切除的肾上腺组织学证实为嗜铬细胞瘤和多个醛固酮分泌性肾上腺微腺瘤。肾上腺切除术后，尿儿茶酚胺水平正常化，高醛固酮血症改善但持续存在。高血压也有所改善但持续存在，并通过螺内酯得到正常化。临床过程表明，PA 病变可能是双侧的。这是一例经组织学证实的同时存在嗜铬细胞瘤和 PA 的病例，其原因为多个醛固酮分泌性微腺瘤。
