A case of aldosterone-producing adenoma with severe postoperative hyperkalemia

Ryoji Taniguchi, Hiroyuki Koshiyama, Mika Yamauchi, Satsuki Tanaka, Daisuke Inoue, Yukihito Sato, Akira Sugawa, Yasunari Muramatsu, Hironobu Sasano

研究成果: Article査読

14 被引用数 (Scopus)

抄録

It is known that some patients with primary aldosteronism show postoperative hyperkalemia, which is due to inability of the adrenal gland to secrete sufficient amounts of aldosterone. However, hyperkalemia is generally neither severe nor prolonged, in which replacement therapy with mineralocorticoid is seldom necessary. We report a case of a 46-year-old woman with an aldosterone-producing adenoma associated with severe postoperative hyperkalemia. After unilateral adrenalectomy, the patient showed episodes of severe hyperkalemia for four months, which required not only cation-exchange resin, but also mineralocorticoid replacement. Plasma aldosterone concentration (PAC) was low, although PAC was increased after rapid ACTH test. Histological examination indicated the presence of adrenocortical tumor and paradoxical hyperplasia of zona glomerulosa in the adjacent adrenal. Immunohistochemistry demonstrated that the enzymes involved in aldosterone synthesis, such as cholesterol side chain cleavage (P- 450(scc)), 3β-hydroxysteroid dehydrogenase (3β-HSD), and 21-hydroxylase (P- 450(c21)), or the enzyme involved in glucocorticoid synthesis, 11β- hydroxylase (P-450(c11β)), were expressed in the tumor, but they were completely absent in zona glomerulosa of the adjacent adrenal. These findings were consistent with the patterns of primary aldosteronism. Serum potassium level was gradually decreased with concomitant increase in PAC. These results suggest that severe postoperative hyperkalemia of the present case was attributable to severe suppression of aldosterone synthesis in the adjacent and contralateral adrenal, which resulted in slow recovery of aldosterone secretion. It is plausible that aldosterone synthesis of adjacent and contralateral adrenal glands is severely impaired in some cases with primary aldosteronism, as glucocorticoid synthesis in Cushing syndrome.

本文言語English
ページ(範囲)215-223
ページ数9
ジャーナルTohoku Journal of Experimental Medicine
186
3
DOI
出版ステータスPublished - 1998 11

ASJC Scopus subject areas

  • 生化学、遺伝学、分子生物学(全般)

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