A Case of Primary Aldosteronism Caused by Multiple Adrenocortical Macronodules
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概要
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A 60-year-old man presented with drug-resistant hypertension with hypokalemia, a high plasma aldosterone concentration (PAC) and suppressed plasma rennin activity (PRA). Imaging examinations showed multiple macronodules in the left adrenal gland. Endocrinological findings demonstrated autonomous aldosterone secretion and 131I-adosterol scintigraphy demonstrated a left sided uptake. Laparoscopic left adrenalectomy normalized serum potassium levels and PAC, and substantially improved hypertension. Pathological and immunohistochemical analysis demonstrated that these nodules were positive for 3β-hydroxysteroid dehydrogenase (HSD3B) but not for CYP17. In addition, zona glomerulosa demonstrated "paradoxical hyperplasia", in which these cells were negative for HSD3B. All of these data indicated that the nodules in the left adrenal gland were mainly responsible for the autonomous aldosterone secretion. We conclude that the primary aldosteronism in this case was caused by multiple macronodules. This is a very rare case of primary aldosteronism caused by multiple adrenocortical macronodules.
著者
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Miyake Hideaki
Division Of Urology Kobe University Graduate School Of Medicine
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Fujisawa Masato
Division Of Urology Department Of Organs Therapeutics Faculty Of Medicine Kobe University Graduate S
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Kawamura Yoko
Division of Food Additives, National Institute of Health Sciences
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Takahashi Yutaka
Division Of Diabetes Metabolism And Endocrinology Department Of Internal Medicine Kobe University Gr
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Murawaki Ayumi
Division Of Diabetes Metabolism And Endocrinology Department Of Internal Medicine Kobe University Gr
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Sasano Hironobu
Department Of Anatomic Pathology Tohoku University School Of Medicine
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Kurahashi Toshifumi
Division Of Urology Department Of Organ Therapeutics Kobe University Graduate School Of Medicine
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Hashimoto Naoko
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Nakamura Tomoaki
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Hirota Yushi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Hirota Yushi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Nishiumi Tomoko
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Sakagushi Kazuhiko
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Sasano Hironobu
Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Japan
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Kurahashi Toshifumi
Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Japan
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Fujisawa Masato
Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Japan
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Kawamura Yoko
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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