Usefulness and limitations of unilateral adrenalectomy for ACTH-independent macronodular adrenal hyperplasia in a patient with poor glycemic control.
Adrenocorticotropic hormone (ACTH)-independent macronodular adrenal hyperplasia (AIMAH) is a rare disease which causes Cushing's syndrome. Bilateral adrenalectomy has been recommended as the treatment of choice for AIMAH. However, bilaterally adrenalectomized patients require lifelong steroid replacement therapy. Therefore, an increasing number of patients have undergone unilateral adrenalectomy for AIMAH. We report a case of AIMAH due to refractory diabetes in whom unilateral adrenalectomy initially yielded good diabetes control, but in whom poor glycemic control developed after 5 years, requiring eventual additional contralateral adrenalectomy. In elderly patients with AIMAH, one-stage bilateral adrenalectomy may be the treatment of choice.
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan. t-koba@tokyo-med.ac.jp
Takaaki
T
Kobayashi
Takashi
T
Miwa
Kenshi
K
Kan
Misato
M
Takeda
Hiroyuki
H
Sakai
Akira
A
Kanazawa
Akihiko
A
Tanaka
Kazunori
K
Namiki
Toshitaka
T
Nagao
Masato
M
Odawara
D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D048909:Diabetes Complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D014057:Tomography, X-Ray Computed
D001786:Blood Glucose; D000324:Adrenocorticotropic Hormone