A Case of Primary Aldosteronism Caused by Multiple Adrenocortical Macronodules

Naoko Hashimoto, Yoko Kawamura, Tomoaki Nakamura, Ayumi Murawaki, Tomoko Nishiumi, Yushi Hirota, Kazuhiko Sakagushi, Toshifumi Kurahashi, Hideaki Miyake, Masato Fujisawa, Hironobu Sasano, Yutaka Takahashi
2011 Internal medicine (Tokyo. 1992)  
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 131 I-adosterol scintigraphy demonstrated a left sided uptake. Laparoscopic left adrenalectomy normalized serum potassium levels and PAC, and substantially improved
more » ... . 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. A 60-year-old man was seen in a hospital because of muscle weakness. He had been treated for hypertension since the age of 40 years old. He was found to have diabetes mellitus when he was 55 years old. He had a history of cerebral hemorrhage at 46 years of age. His grandfather had stroke, and his father had hypertension, dyslipidemia, stroke
doi:10.2169/internalmedicine.50.4280 pmid:21422683 fatcat:7zvvosadqne55i5bpmcwzw3hqq