Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma
A 47-year-old woman with a history of diabetes mellitus (DM) and obesity was admitted to our hospital for glucose control. She was detected to have hypertension (HT) and diagnosed with primary aldosteronism (PA) based on the high level of aldosterone to renin ratio and the results of the upright fur...
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| Format: | Article |
| Language: | English |
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2020-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2020/2808101 |
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| author | Kazuhito Oba Yuko Chiba Yoko Matsuda Takeshi Kumakawa Rie Aoyama Miho Akahoshi Seiji Hashimoto Aya Tachibana Koichi Toyoshima Remi Kodera Kenji Toyoshima Yoshiaki Tamura Takashi Nagata Yuto Yamazaki Hironobu Sasano Atsushi Araki |
| author_facet | Kazuhito Oba Yuko Chiba Yoko Matsuda Takeshi Kumakawa Rie Aoyama Miho Akahoshi Seiji Hashimoto Aya Tachibana Koichi Toyoshima Remi Kodera Kenji Toyoshima Yoshiaki Tamura Takashi Nagata Yuto Yamazaki Hironobu Sasano Atsushi Araki |
| author_sort | Kazuhito Oba |
| collection | DOAJ |
| description | A 47-year-old woman with a history of diabetes mellitus (DM) and obesity was admitted to our hospital for glucose control. She was detected to have hypertension (HT) and diagnosed with primary aldosteronism (PA) based on the high level of aldosterone to renin ratio and the results of the upright furosemide-loading test according to the criteria of the Japanese Society of Hypertension (JSH) guidelines. Computed tomography revealed left renal tumor and adrenocortical adenoma. She underwent left nephrectomy and adrenalectomy. The pathological findings were clear-cell renal cell carcinoma (RCC) and nonfunctional adrenocortical adenoma. Her nonneoplastic adrenal tissue histologically revealed CYP11B2-positive multiple adrenocortical micronodules (MNs) and concomitant paradoxical hyperplasia of the zona glomerulosa. Therefore, MNs were thought to be responsible for PA in this patient. After surgery, HT was improved, and the result of upright furosemide-loading test after 12 months of surgery did not fulfill the criteria of PA according to the JSH guidelines. However, the adrenocorticotrophic hormone stimulation test was positive; considering the possibility of slight aldosterone overproduction from the right adrenal gland, the administration of spironolactone was started. Herein, we report a rare case of RCC in conjunction with PA histologically associated with MNs. |
| format | Article |
| id | doaj-art-5f51774843fc4414b3b44b0c52a968cc |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-5f51774843fc4414b3b44b0c52a968cc2025-02-03T05:49:55ZengWileyCase Reports in Endocrinology2090-65012090-651X2020-01-01202010.1155/2020/28081012808101Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell CarcinomaKazuhito Oba0Yuko Chiba1Yoko Matsuda2Takeshi Kumakawa3Rie Aoyama4Miho Akahoshi5Seiji Hashimoto6Aya Tachibana7Koichi Toyoshima8Remi Kodera9Kenji Toyoshima10Yoshiaki Tamura11Takashi Nagata12Yuto Yamazaki13Hironobu Sasano14Atsushi Araki15Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartment of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartment of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanDepartment of Urology, Tokyo Metropolitan Geriatric Hospital, Tokyo, JapanDepartment of Pathology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Pathology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital Tokyo, Tokyo, JapanA 47-year-old woman with a history of diabetes mellitus (DM) and obesity was admitted to our hospital for glucose control. She was detected to have hypertension (HT) and diagnosed with primary aldosteronism (PA) based on the high level of aldosterone to renin ratio and the results of the upright furosemide-loading test according to the criteria of the Japanese Society of Hypertension (JSH) guidelines. Computed tomography revealed left renal tumor and adrenocortical adenoma. She underwent left nephrectomy and adrenalectomy. The pathological findings were clear-cell renal cell carcinoma (RCC) and nonfunctional adrenocortical adenoma. Her nonneoplastic adrenal tissue histologically revealed CYP11B2-positive multiple adrenocortical micronodules (MNs) and concomitant paradoxical hyperplasia of the zona glomerulosa. Therefore, MNs were thought to be responsible for PA in this patient. After surgery, HT was improved, and the result of upright furosemide-loading test after 12 months of surgery did not fulfill the criteria of PA according to the JSH guidelines. However, the adrenocorticotrophic hormone stimulation test was positive; considering the possibility of slight aldosterone overproduction from the right adrenal gland, the administration of spironolactone was started. Herein, we report a rare case of RCC in conjunction with PA histologically associated with MNs.http://dx.doi.org/10.1155/2020/2808101 |
| spellingShingle | Kazuhito Oba Yuko Chiba Yoko Matsuda Takeshi Kumakawa Rie Aoyama Miho Akahoshi Seiji Hashimoto Aya Tachibana Koichi Toyoshima Remi Kodera Kenji Toyoshima Yoshiaki Tamura Takashi Nagata Yuto Yamazaki Hironobu Sasano Atsushi Araki Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma Case Reports in Endocrinology |
| title | Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma |
| title_full | Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma |
| title_fullStr | Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma |
| title_full_unstemmed | Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma |
| title_short | Primary Aldosteronism Associated with Multiple Adrenocortical Micronodules in a Patient with Renal Cell Carcinoma |
| title_sort | primary aldosteronism associated with multiple adrenocortical micronodules in a patient with renal cell carcinoma |
| url | http://dx.doi.org/10.1155/2020/2808101 |
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