title: Coexistence of aldosterone-producing adrenocortical adenoma and pheochromocytoma in an ipsilateral adrenal gland.
abstract: A 40-year-old female, diagnosed as essential hypertension, demonstrated a 2 cm mass in left adrenal gland by computed tomography without abnormal endocrinological findings. (131)I-adosterol and (123)I-metaiodobenzylguanidine (MIBG) scintigraphy at 39 years of age showed no abnormal accumulation. Follow up (131)I-adosterol scintigraphy performed one year later showed apparently abnormal uptake and slightly elevated uptake in left adrenal gland. Her physical examination was unremarkable except for mild hypertension. Routine blood chemistry was normal except for hypokalemia. Endocrinological date revealed suppressed plasma renin activity, and elevated plasma aldosterone concentration, and noradrenalin levels. Serial T2-weighted magnetic resonance imaging clearly demonstrated two distinct tumors. Furthermore, selective adrenal venous sampling with intravenous ACTH infusion indicated aldosterone-producing adrenocortical adenoma (APA) in left adrenal gland. During operation of adrenal tumor, blood pressure elevated markedly and complication of pheochromocytoma (PC) was suspected. Immunohistochemical findings after left adrenolectomy revealed that the adrenal mass was compatible with APA and PC. Risk of operation against undiagnosed PC is very high and, therefore, it must be diagnosed before surgery. Herein, we present an extremely rare case of the simultaneous occurrence of both APA and PC in an ipsilateral adrenal gland.
authors.affiliation: Division of Diabetes and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Tojo
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Saito
authors.forename: Kei
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Isaka
authors.forename: Naoko
authors.initials: N
authors.lastname: Tajima
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamada
authors.forename: Nozomu
authors.initials: N
authors.lastname: Furuta
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000473:pathology*; D000311:Adrenal Glands / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000473:pathology*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000150:complications; D033162:Incidental Findings; D009378:Neoplasms, Multiple Primary; D010673:Pheochromocytoma / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone