Rao A, Melby J C
Evans Department of Clinical Research, Boston University Medical Center, USA.
J Endocrinol Invest. 1997 Jan;20(1):29-31. doi: 10.1007/BF03347969.
Primary hyperaldosteronism (adrenal adenoma and idiopathic hyperplasia) is a disorder with hypertension, hypokalemia, elevated serum aldosterone and suppressed plasma renin activity. Hyperplasia is managed medically whereas adenomas are treated surgically. Selective adrenal venous catheterization and aldosterone measurement is a useful tool in making the distinction in 95% of cases. We report a case of bilateral idiopathic hyperplasia of the adrenal glands adequately treated with medications for 6 years followed by worsening. Selective catheterization was consistent with a right sided adenoma. Surgical removal of the right adrenal gland alleviated her symptoms. Pathological examination showed focal nodular hyperplasia. We propose that in the course of the disease the focal hyperplastic nodule became autonomous and behaved like an adenoma. Monitoring of patients with adrenal hyperplasia for recurrence of symptoms is prudent as surgery is beneficial in patients who develop an autonomous nodule.
原发性醛固酮增多症（肾上腺腺瘤和特发性增生）是一种伴有高血压、低钾血症、血清醛固酮升高和血浆肾素活性受抑制的疾病。增生采用药物治疗，而腺瘤则通过手术治疗。选择性肾上腺静脉插管和醛固酮测量是在95%的病例中进行鉴别的有用工具。我们报告一例双侧肾上腺特发性增生患者，药物治疗6年病情控制良好，但随后病情恶化。选择性插管检查结果提示右侧腺瘤。手术切除右侧肾上腺后症状缓解。病理检查显示为局灶性结节性增生。我们认为在疾病过程中，局灶性增生结节变得自主，表现得像腺瘤。对于肾上腺增生患者，谨慎监测症状复发情况很有必要，因为对于出现自主结节的患者，手术治疗有益。
