title: Primary aldosteronism with aldosterone-producing adenoma consisting of pure zona glomerulosa-type cells in a pregnant woman.
abstract: Aldosterone-producing adenoma (APA) consisting of pure zona glomerulosa (ZG)-type cells is extremely rare, and primary aldosteronism complicated by pregnancy is also rare. We report a case of APA discovered in a 32-year-old pregnant woman who visited our hospital for hypertension and hypokalemia at 26 weeks gestation. Elevated plasma aldosterone concentration and hypokalemia were observed, and an magnetic resonance imaging scan demonstrated a right adrenal mass. A laparoscopic adrenalectomy was performed because of refractory hypokalemia. Pathologically, the adrenal mass was diagnosed as APA, and in addition to the cytological features, in situ hybridization and real-time polymerase chain reaction proved that all the component cells were ZG-type cells. The cells also showed estrogen receptor beta immunoreactivity and melanocortin 2 receptor mRNA expression, suggesting that estrogen and/or ACTH might be related to the proliferation of APA cells during pregnancy. Our case is the first report of APA consisting of ZG-type cells discovered during pregnancy.
authors.affiliation: Department of Pathology, Japanese Red-Cross Nagasaki Atomic Bomb Hospital, Nagasaki, 852-8511, Japan. shigek@net.nagasaki-u.ac.jp
authors.forename: Kazuto
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Nishida
authors.forename: Hideki
authors.initials: H
authors.lastname: Sakai
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Igawa
authors.forename: Shin
authors.initials: S
authors.lastname: Suzuki
authors.forename: Kioko
authors.initials: K
authors.lastname: Kawai
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahara
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D047629:Estrogen Receptor beta / Q000096:biosynthesis; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology* / Q000473:pathology; D006973:Hypertension / Q000209:etiology; D007008:Hypokalemia / Q000209:etiology; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism / Q000473:pathology*; D012333:RNA, Messenger / Q000032:analysis; D044103:Receptor, Melanocortin, Type 2 / Q000096:biosynthesis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D015384:Zona Glomerulosa / Q000378:metabolism / Q000473:pathology*
chemical_list: D047629:Estrogen Receptor beta; D012333:RNA, Messenger; D044103:Receptor, Melanocortin, Type 2; D000450:Aldosterone