Otsuka F, Otsuka-Misunaga F, Koyama S, Yamanari H, Ogura T, Ohe T, Makino H
Department of Medicine III, Okayama University Medical School, Japan.
J Endocrinol Invest. 1998 Sep;21(8):531-6. doi: 10.1007/BF03347340.
A case of unilateral adrenocortical hyperplasia is presented. A 46-year-old woman with a 7-year history of hypertension and a 1-year-history of hypokalemia was diagnosed with primary aldosteronism. Computed tomography, magnetic resonance imaging, venous sampling and adosterol scintigraphy exhibited a functioning left adrenal mass. The plasma aldosterone concentration increased markedly when furosemide with upright posture and either captopril or adrenocorticotropin were administered. Plasma renin activity was suppressed below the detectable range. Aldosterone secretion displayed a circadian rhythm and was not suppressed by dexamethasone administration. The resected left adrenal mass was pathologically diagnosed as adrenocortical nodular hyperplasia. Unilateral adrenal hyperplasia involving the zona glomerulosa rarely has been reported, with varying and incompletely characterized hormonal characteristics. This case report and literature review suggest unilateral adrenal hyperplasia as a rare cause of hyperaldosteronism with characteristics intermediate between idiopathic hyperaldosteronism and aldosterone-producing adrenocortical adenoma, resembling the functional features of the adenoma more closely.
本文报告一例单侧肾上腺皮质增生病例。一名46岁女性，有7年高血压病史和1年低钾血症病史，被诊断为原发性醛固酮增多症。计算机断层扫描、磁共振成像、静脉采血和醛固酮闪烁扫描显示左肾上腺有一功能性肿块。在速尿直立位并给予卡托普利或促肾上腺皮质激素时，血浆醛固酮浓度显著升高。血浆肾素活性被抑制至检测范围以下。醛固酮分泌呈现昼夜节律，且地塞米松给药不能抑制。切除的左肾上腺肿块经病理诊断为肾上腺皮质结节性增生。累及球状带的单侧肾上腺增生很少见报道，其激素特征各异且描述不完全。本病例报告及文献复习提示单侧肾上腺增生是醛固酮增多症的罕见病因，其特征介于特发性醛固酮增多症和醛固酮分泌性腺瘤之间，更接近腺瘤的功能特征。
