A Case of Primary Aldosteronism Caused by Multiple Adrenocortical Macronodules

Naoko Hashimoto, Yoko Kawamura, Tomoaki Nakamura, Ayumi Murawaki, Tomoko Nishiumi, Yushi Hirota, Kazuhiko Sakagushi, Toshifumi Kurahashi, Hideaki Miyake, Masato Fujisawa, Hironobu Sasano, Yutaka Takahashi

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3 Citations (Scopus)


A 60-year-old man presented with drug-resistant hypertension with hypokalemia, a high plasma aldosterone concentration (PAC) and suppressed plasma rennin activity (PRA). Imaging examinations showed multiple macronodules in the left adrenal gland. Endocrinological findings demonstrated autonomous aldosterone secretion and 131I-adosterol scintigraphy demonstrated a left sided uptake. Laparoscopic left adrenalectomy normalized serum potassium levels and PAC, and substantially improved hypertension. Pathological and im-munohistochemical analysis demonstrated that these nodules were positive for 3β-hydroxysteroid dehydrogenase (HSD3B) but not for CYP17. In addition, zona glomerulosa demonstrated “paradoxical hyperplasia“, in which these cells were negative for HSD3B. All of these data indicated that the nodules in the left adrenal gland were mainly responsible for the autonomous aldosterone secretion. We conclude that the primary aldosteronism in this case was caused by multiple macronodules. This is a very rare case of primary aldosteronism caused by multiple adrenocortical macronodules.

Original languageEnglish
Pages (from-to)585-590
Number of pages6
JournalInternal Medicine
Issue number6
Publication statusPublished - 2011
Externally publishedYes


  • 3beta-hydroxysteroid dehydrogenase
  • Macronodule
  • Primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine


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