title: Bilateral aldosterone-producing adenomas in two patients diagnosed by immunohistochemical analysis of steroidogenic enzymes.
abstract: Bilateral adrenal aldosterone-producing adenomas (APA) are rare. It is important to distinguish bilateral APA from idiopathic hyperaldosteronism (IHA) which is due to bilateral hyperplasia of the adrenal cortex. We present two patients with bilateral APA in whom the diagnosis was made histochemically by analyzing steroidogenic enzymes. They showed hypokalemia, high plasma aldosterone concentration (PAC) and suppressed plasma renin activity (PRA). Bilateral adrenal tumors were represented by computed tomography, and surgical resection was performed. In both cases, cytochrome P-450 and other enzymes that were involved in aldosterone synthesis were found mainly in tumor, but little in the zona glomerulosa of the adjacent adrenals, which showed paradoxical hyperplasia. Such cases are difficult to distinguish from IHA. The two disorders were differentiated by immunohistochemical analysis of steroidogenic enzymes.
authors.affiliation: Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Watanabe
authors.forename: K
authors.initials: K
authors.lastname: Tsunoda
authors.forename: H
authors.initials: H
authors.lastname: Sasano
authors.forename: K
authors.initials: K
authors.lastname: Omata
authors.forename: Y
authors.initials: Y
authors.lastname: Imai
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.forename: K
authors.initials: K
authors.lastname: Abe
mesh_terms: D015096:3-Hydroxysteroid Dehydrogenases / Q000378:metabolism; D000236:Adenoma / Q000175:diagnosis* / Q000201:enzymology / Q000378:metabolism*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000201:enzymology / Q000378:metabolism*; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications; D000328:Adult; D000450:Aldosterone / Q000096:biosynthesis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000209:etiology; D007150:Immunohistochemistry; D013252:Steroid 11-beta-Hydroxylase / Q000378:metabolism; D013256:Steroids / Q000096:biosynthesis; D014057:Tomography, X-Ray Computed
chemical_list: D013256:Steroids; D000450:Aldosterone; D015096:3-Hydroxysteroid Dehydrogenases; D013252:Steroid 11-beta-Hydroxylase