title: A case of primary aldosteronism due to unilateral adrenal hyperplasia.
abstract: The case of a patient with primary aldosteronism due to unilateral adrenal hyperplasia (UAH) is reported. A 43-year-old man with an 8-year history of hypertension presented at our institution with hypokalemia, increased plasma aldosterone concentration (PAC), and suppressed plasma renin activity (PRA). An abdominal CT scan showed almost normal adrenal glands with slight enlargement in the left gland. 131I-Norcholesterol adrenal scintigraphy under dexamethasone suppression showed bilaterally decreased uptake. To rule out idiopathic hyperaldosteronism, an adrenal vein sampling before and after ACTH stimulation was performed and a left-sided lateralization of PAC was observed. A left adrenalectomy was performed, and the patient had a good clinical and biochemical response. Micronodular hyperplasia was discovered in the adrenal gland histologically, and in the immunohistochemical analysis, positive staining for 3beta-hydroxysteroid dehydrogenase in micronodular lesions confirmed the diagnosis of UAH. Although UAH is a rare subset of primary aldosteronism, it is surgically correctable as a unilateral autonomous aldosterone-producing lesion. Careful investigations, including bilateral adrenal vein sampling, should be performed for the diagnosis.
authors.affiliation: Department of Internal Medicine, Japan Self Defense Forces Central Hospital, Tokyo, Japan. yasukatayama@dream.com
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Katayama
authors.forename: Nobuki
authors.initials: N
authors.lastname: Takata
authors.forename: Taiji
authors.initials: T
authors.lastname: Tamura
authors.forename: Akemi
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Hirata
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yasuda
authors.forename: Susumu
authors.initials: S
authors.lastname: Matsukuma
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Daido
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
mesh_terms: D000311:Adrenal Glands / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006965:Hyperplasia; D006973:Hypertension / Q000209:etiology / Q000473:pathology*; D008297:Male