The potential of computed tomography volumetry for the surgical treatment in bilateral macronodular adrenal hyperplasia: A case report

Hiromu Matsunaga, Yuta Tezuka, Tomo Kinoshita, Hiroko Ogata, Yuto Yamazaki, Beata Shiratori, Kei Omata, Yoshikiyo Ono, Ryo Morimoto, Masataka Kudo, Kazumasa Seiji, Kei Takase, Yoshihide Kawasaki, Akihiro Ito, Hironobu Sasano, Hideo Harigae, Fumitoshi Satoh

Research output: Contribution to journalArticlepeer-review

Abstract

Although adrenal resection is a major option to control hypercortisolemia in patients with bilateral macronodular adrenal hyperplasia, a predictive method for postoperative cortisol production has not been established. A 53-year-old man with ulcerative colitis was referred to our hospital for bilateral multiple adrenal nodules and hypertension. Physical and endocrinological examination revealed inappropriate cortisol production and suppressed secretion of adrenocorticotropic hormone with no typical signs of Cushing’s syndrome. Imaging analysis revealed bilateral adrenal nodular enlargement, the nodules of which had the radiological features of adrenocortical adenomas without inter-nodular heterogeneity. In addition, computed tomography volumetry demonstrated that the left adrenal gland (70 mL) accounts for three quarters of the total adrenal volume (93 mL). The patient was diagnosed as subclinical Cushing’s syndrome due to bilateral macronodular adrenal hyperplasia, and subsequently underwent a left laparoscopic adrenalectomy with the estimation of 75% decrease in the cortisol level based on the adrenal volume. The surgical treatment ultimately resulted in control of the cortisol level within the normal range, which was compatible to our preoperative prediction. However, regardless of the sufficient cortisol level, ulcerative colitis was exacerbated after the surgery, which needed a systemic therapy for remission. This case indicates successful surgical control of hypercortisolemia based on computed tomography volumetry in bilateral macronodular adrenal hyperplasia, as well as the perioperative exacerbation risk for inflammatory diseases in Cushing’s syndrome. We report the potential utility of computed tomography volumetry as a quantitative method with retrospective evaluation of our historical cases.

Original languageEnglish
Pages (from-to)143-150
Number of pages8
JournalTohoku Journal of Experimental Medicine
Volume253
Issue number2
DOIs
Publication statusPublished - 2021
Externally publishedYes

Keywords

  • Bilateral macronodular adrenal hyperplasia
  • Computed tomography volumetry
  • Cushing’s syndrome
  • Hypertension
  • Ulcerative colitis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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