A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone
A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone
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DOI：
10.1507/endocrj.48.103
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发表时间：
2001-02-01
影响因子：
2
通讯作者：
Sasano, H
中科院分区：
文献类型：
--
作者：
Makino, S;Oda, S;Sasano, H
一个罕见的病例醛固酮产生肾上腺皮质腺瘤与临床前库欣综合征和甲状旁腺激素（PTH）的高分泌被描述。患者男，64岁，高血压史20年，低钾血症4年。他因脑出血而患有左偏瘫和失语，但他的外表不是库欣古德。血浆肾素活性低于正常范围，血浆醛固酮浓度偏高。他们对速尿直立试验没有反应。早晨血浆皮质醇水平在正常范围的上限，但它没有显示昼夜节律，也没有被1毫克和8毫克地塞米松抑制。计算机断层扫描显示右肾上腺低密度肿瘤。地塞米松治疗下的肾上腺闪烁图显示右侧示踪剂的摄取，肾上腺静脉血浆醛固酮和皮质醇浓度在右侧高于另一侧。右侧醛固酮分泌肾上腺腺瘤伴自主分泌皮质醇，经右侧肾上腺切除术确诊。组织学表现为腺瘤主要由透明细胞组成，但致密细胞巢分散。对腺瘤提取物的分析显示，腺瘤含有过量的醛固酮，皮质醇/皮质酮的比例高于醛固酮分泌腺瘤。肾上腺切除术后一年，血清钙和甲状旁腺素水平仍然很高。超声检查显示左侧甲状旁腺肿胀，提示自发性甲状旁腺功能亢进并存。
A rare case of aldosterone-producing adrenocortical adenoma with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone (PTH) is described. A 64-year-old male patient had a history of hypertension for two decades and hypokalemia for 4 years. He suffered from left hemiparesis and aphasia due to cerebral hemorrhage, but his appearance was not Cushingoid. His plasma renin activity was below the normal range, while plasma aldosterone concentration was high. They did not respond to furosemide-upright test. His plasma cortisol level in the morning was at the upper limit of the normal range, but it did not show a diurnal rhythm nor was it suppressed by 1 mg and 8 mg of dexamethasone. Computed tomography showed a low density tumor in the right adrenal gland. An adrenal scintigram under dexamethasone treatment revealed an uptake of the tracer on the right side, and plasma aldosterone and cortisol concentrations in the adrenal vein were higher on the right side than on the opposite. The diagnosis of right aldosterone-producing adrenal adenoma with an autonomous production of cortisol was confirmed by right adrenalectomy. Histological findings showed an adenoma consisting mostly of clear cells, but that the nests of compact cells were scattered. Analysis of an extract from the adenoma revealed that the adenoma contained an excess amount of aldosterone and that the cortisol/corticosterone ratio was higher than that of aldosterone-producing adenoma. Both serum calcium and PTH levels remained high one year after adrenalectomy. Ultrasonography revealed the swelling of a parathyroid gland on the left side, indicating the coexistence of an autonomous hyperparathyroidism.