Watanabe N, Abe K, Tsunoda K, Imai Y, Hsu-Lang S, Murakami O, Suzuki T, Sasano K, Yoshinaga K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Nihon Naibunpi Gakkai Zasshi. 1993 Feb 20;69(2):80-6. doi: 10.1507/endocrine1927.69.2_80.
A 43-year-old female was admitted to our hospital for high blood pressure control. She showed hypokalemia with increased urinary potassium excretion, high plasma aldosterone concentration (33.9ng/dl, normal range; 2-12ng/dl) and reduced plasma renin activity (trace, normal range; 0.83-5ng/ml/hr). Bilateral adrenal tumors were revealed by abdominal computed tomography, and left adrenalectomy and right partial adrenalectomy were performed. Cytochromes p-450 and other enzymes involved in aldosterone synthesis were found predominantly in the tumor portions but not in the zona glomerulosa of the attached adrenals, which histopathologically showed paradoxical hyperplasia. This was a rare case of bilateral aldosterone-producing adrenal adenomas, which we could differentiate from idiopathic hyperaldosteronism by employing immunohistochemical analysis of steroidogenic enzymes.
一名43岁女性因控制高血压入住我院。她表现为低钾血症，尿钾排泄增加，血浆醛固酮浓度升高（33.9ng/dl，正常范围2 - 12ng/dl），血浆肾素活性降低（微量，正常范围0.83 - 5ng/ml/hr）。腹部计算机断层扫描显示双侧肾上腺肿瘤，遂行左侧肾上腺切除术和右侧肾上腺部分切除术。参与醛固酮合成的细胞色素p - 450和其他酶主要在肿瘤部分发现，而在所附着肾上腺的球状带中未发现，组织病理学显示为矛盾性增生。这是一例罕见的双侧醛固酮分泌性腺瘤，我们通过对类固醇生成酶进行免疫组化分析，将其与特发性醛固酮增多症区分开来。
