重複癌 (甲状腺癌・直腸癌) を合併した原発性アルドステロン症の一剖検例

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Described here is a patient, suffering from both primary aldosteronism and a primary double cancer of the thyroid and rectum, who died of meningo-encephalitis due to Listeria monocytogenes. The patient, a 57-year-old man, was admitted to Tenri hospital in January, 1977, for analysis of hoarseness and a solitary nodule in the thyroid. Physical examination revealed a well-nourished man with a left-sided solitary nodule in the thyroid associated with the enlargement of neighboring lymph nodes and recurrent nerve involvement. The thyroid scintigram, obtained 24 hours after 131I administration, demonstrated less activity in the nodule than in the adjacent thyroid tissue, showing the nonfunctioning nodule. Thyroxine, triiodothyronine and TSH concentrations in serum were almost within normal limits. Thus, he was diagnosed as having thyroid cancer, and the removal of the nodule and of the enlarged lymph nodes was performed in February, 1977. The histological diagnosis was pappillo-follicular adenocarcinoma of the thyroid. The metastasis to lymph nodes was also found. In addition to the thyroid cancer, it was noted that his blood pressure was 160-192/ 60-120 mm.Hg, and the serum potassium concentrations were under 3 mEq./L. in repeated determinations. The renal potassium clearance rate was 44.9 ml./min. (normal range : 10-30 ml./min.) on loading of Na2S2O3, indicating an excess loss of potassium through urinary excretion. The distinct elevations of the supine plasma aldosterone concentration (PAC, 55 ng/100 ml.) and urinary aldosterone excretion (24 μg/day), which were determined by radioimmunoassay, were found on ordinary sodium intake (120 mEq./day). On the other hand, the supine plasma renin activity (PRA), determined by radioimmunoassay, was below the limit of detection on ordinary sodium intake. When sodium intake was restricted (10 mEq./day), the plasma potassium level increased to the low-normal range, while the increment of PRA was negligible, even when an upright position was sustained for 2 hours and furosemide was injected simultaneously. Moreover, the serum potassium level also increased to a low-normal range after the administration of spironolactone, but glucocorticoid administration had no effect on the diminished potassium level in plasma and on hypertension. Plasma cortisol concentrations were 17.5 μg/100 ml. at 9 : 00 AM and 9.5 μg/100 ml. at 5 : 00 PM. Urinary 17 OHCS and 17 KS excretion were within normal limits. Thus, the results were consistent with the clinical diagnosis of primary aldosteronism. During further evaluation of the primary aldosteronism, the patient suffered from headache, nausea and vomiting associated with high fever, and rapidly lapsed into a coma. Lumbar puncture revealed cloudy fluid under an initial pressure equivalent to 350 mm. of water. The fluid contained 313 white cells per cubic millimeter, showing mainly neutrophils. The smear and culture showed gram-positive rods, suggesting Listeria monocytogenes. Although antibiotic therapy was promptly instituted, he died 14 days after the onset of his illness. Autopsy was performed about 6 hours after death. A yellow tumor (1.4 × 1.2 × 0.7 cm in size and 0.5 g in wet weight) was found in the right adrenal gland. Rare mitotic figures and no pleomorphism on light microscopic examination sustained the diagnosis of adrenal adenoma. There was residual thyroid cancer in the right lobe of the thyroid. Moreover, a small tumor (about 1 cm. in diameter) was found in the rectum, and the histological diagnosis was adenocarcinoma, which was apparently different from that of the thyroid histologically, indicating a primary double cancer of the thyroid and rectum. There were several microabscesses in the basal ganglia and the mid-brain and histiocyte included gram-positive rods found in the abscess.
日本内分泌学会の論文

重複癌 (甲状腺癌・直腸癌) を合併した原発性アルドステロン症の一剖検例

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