title: A case of bilateral aldosterone-producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery.
abstract: Primary aldosteronism due to unilateral aldosterone-producing adenoma (APA) is a surgically curable form of hypertension. Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral idiopathic hyperaldosteronism (IHA) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old man with marked long-standing hypertension was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked hypertension, hypokalaemia, elevated plasma aldosterone concentration (PAC) of 45.1 ng dl(-1) and aldosterone renin activity ratio of 90.2 (ng dl(-1) per ng ml(-1 )h(-1)), which was still high after 50 mg-captopril loading. CT revealed bilateral adrenocortical tumours of 10 and 12 mm in diameter on the right and left sides, respectively. S-AVS confirmed excess aldosterone secretion from a tumour segment vein and suppressed secretion from a non-tumour segment vein bilaterally, leading to the diagnosis of bilateral APA. The patient underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2 ng dl(-1) confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from IHA by direct evaluation of intra-adrenal hormone production.
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Morimoto
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Satani
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iwakura
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nezu
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.|Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Omata
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.|Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tezuka
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Seiji
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
authors.forename: H
authors.identifier: 0000-0002-7239-3152
authors.initials: H
authors.lastname: Ota
authors.affiliation: Department of Urology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Department of Urology, Tohoku University Hospital, Sendai, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ishidoya
authors.affiliation: Department of Pathology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Urology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takase
authors.affiliation: Department of Pathology, Tohoku University Hospital, Sendai, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sasano
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.affiliation: Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Japan.|Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Satoh
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000450:Aldosterone / Q000097:blood* / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000097:blood* / Q000378:metabolism; D001706:Biopsy; D001800:Blood Specimen Collection / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D059351:Organ Sparing Treatments; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014680:Veins
chemical_list: D014408:Biomarkers, Tumor; D000450:Aldosterone