Departmental Bulletin Paper 片側副腎摘除にて高血糖が改善したACTH 非依存性大結節性副腎皮質過形成(AIMAH)の1例
Improvement in Hyperglysemia Following Unilateral Adrenalectomy for ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH) : A Case Report

池田, 純一  ,  六車, 光英  ,  井上, 貴昭  ,  西田, 晃久  ,  川喜多, 繁誠  ,  室田, 卓之  ,  大杉, 治之  ,  滝澤, 奈恵  ,  木下, 秀文  ,  松田, 公志  ,  野田, 亜未香  ,  宇都宮, 啓太

63 ( 1 )  , pp.7 - 10 , 2017-01-31 , 泌尿器科紀要刊行会
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.

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