A case of adrenocorticotropin-independent bilateral adrenal macronodular hyperplasia (AIMAH) with primary hyperparathyroidism (PHPT).
We report a rare case of ACTH-independent macronodular adrenal hyperplasia (AIMAH) with primary hyperparathyroidism (PHPT). A 57-year-old woman was admitted to our hospital for further examination of secondary hypertension and bilateral adrenal macrotumors. Midnight serum cortisol elevation with undetectable plasma ACTH, increased 24-hour urinary free cortisol excretion, and loss of the normal circadian rhythm in cortisol secretion established the diagnosis of Cushing's syndrome. Total resection of the enlarged left adrenal gland was performed with subsequent steroid replacement. Her general condition improved but serum calcium level increased 3 weeks after surgery. PHPT was diagnosed on the basis of endocrinological examination, although imaging studies failed to detect parathyroid lesion. In summary, we believe this to be the first report of a case of AIMAH with PHPT.
Division of Nephrology and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Mikano
M
Sato
Masayoshi
M
Soma
Tomohiro
T
Nakayama
Kotoko
K
Kosuge
Ryou
R
Suzuki
Kazuyoshi
K
Okada
Kazutoshi
K
Komatsu
Masahiko
M
Sugitani
Koichi
K
Matsumoto
D000307:Adrenal Gland Diseases / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D002118:Calcium / Q000097:blood; D003480:Cushing Syndrome / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006934:Hypercalcemia / Q000175:diagnosis / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D006965:Hyperplasia / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D000324:Adrenocorticotropic Hormone; D002118:Calcium; D006854:Hydrocortisone