高齢者にみられた糖質コルチコイド反応性アルドステロン症における各種ステロイド分泌動態

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A 54-year-old man was admitted to our hospital on July 18, 1980. His familial history showed no hypertension and his past medical history was not significant. At the age of 39, hypertension (220/-mmHg) was first diagnosed, but it was not improved by antihypertensive therapy. Moreover, at the age of 53, hypertension (220/110 mmHg), hypokalemia, low plasma renin activity (PRA) and significant high plasma aldosterone concentrations (PAC) were indicated.<BR>Laboratory findings disclosed hypokalemia (2.9 mEq/l) and metabolic alkalosis. A high PAC of 20.4 ng/dl and a low PRA of 0 ng/ml/h were detected. PRA was suppressed to 0 ng/ml/h even after quiet ambulation for 2 hours with the administration of 1 mg/kg furosemide. Urinary excretion rates of 17-OHCS and 17-KS were within normal limits. Retroperitoneal pneumography, computed tomography and adrenal scintiscan all failed to detect adrenal adenoma, but a right adrenal adenoma was suspected with the determination of PAC in the renal veins. The pathological findings of the excised adrenal gland showed hyperplasia of the zona glomerulosa and the subglomerulosa. After the adrenalectomy, the hypertension and hypokalemia did not improve. Plasma ACTH was within normal limits at 81 pg/ml. Relatively high levels of plasma deoxycorticosterone, 18-hydroxydeoxycortico-sterone, corticosterone and 18-hydroxycorticosterone were found. Plasma levels of glucocorticoids and androgens were within the normal range, and urinary excretion rates of pregnandiol and pregnantriol were normal. PAC was significantly increased by exogenous ACTH administration. Administration of dexamethasone decreased the blood pressure from 210/110 mmHg to 140/80 mmHg and increased the serum potassium from 3.0 mEq/1 to 4.2 mEq/l, the PRA from 0 ng/ml/h to 1.2 ng/ml/h, and the suppressed PAC to 0 ng/dl.<BR>The data suggest that the high level of aldosterone in the patient depended upon the fact that the receptors in the aldosterone-producing cells of the adrenal glands were congenitally sensitive to endogenous ACTH rather than angiotensin II.
日本内分泌学会の論文

高齢者にみられた糖質コルチコイド反応性アルドステロン症における各種ステロイド分泌動態

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