title: [Improvement in Hyperglysemia Following Unilateral Adrenalectomy for ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH) : A Case Report].
abstract: Adrenal corticotropin (ACTH) -independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is the treatment of choice, but lifetime steroid replacement is essential. Here we report a case of AIMAH whose hyperglycemia was improved following unilateral adrenalectomy. A 42-year-old woman with serious intellectual disability and intractable epilepsy presented with polydipsia. Casual blood glucose and hemoglobin A1c (HbA1c) were 322 mg/dl and 8.5%, respectively. The cortisol level was high and ACTH level was low. Abdominal computed tomography and magnetic resonance imaging revealed unsuspected macronodular enlargement of bilateral adrenal glands (left 8 cm, right 4 cm in maximal diameter) and she was diagnosed with AIMAH. Both adrenal glands showed intense 131 I-adosterol accumulation predominantly in the left side and left-unilateral laparoscopic adrenalectomy was performed. Both insulin and oral antidiabetic drugs could be cancelled postoperatively, and HbA1c decreased to 5.7%. Steroid was not replaced but she never experienced adrenal crisis. We conclude that unilateral adrenalectomy is a safe and effective treatment for certain cases of AIMAH.
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ikeda
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Kouei
authors.initials: K
authors.lastname: Muguruma
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Nishida
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Shigenari
authors.initials: S
authors.lastname: Kawakita
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Medical Center.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murota
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Hospital.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ohsugi
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Hospital.
authors.forename: Nae
authors.initials: N
authors.lastname: Takizawa
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Hospital.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: The Department of Urology and Andrology, Kansai Medical University Hospital.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: The Department of Medicine II, Kansai Medical University.
authors.forename: Amika
authors.initials: A
authors.lastname: Noda
authors.affiliation: The Department of Radiology, Kansai Medecal University.
authors.forename: Keita
authors.initials: K
authors.lastname: Utsunomiya
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D016896:Treatment Outcome