副腎皮質腺腫摘除によって治癒せしめたCushing's Syndromeの1例

Abstract

1)Cushing'sSyndromeを呈する37才の女子に右副腎腫瘍摘出術を行なつて術後劇的な症状の消失をもたらすことができた.2)摘除腫瘍は3.2×2.8×2.Ocm7.5gで球形を呈し組織学的に腺腫であつた.3)手術に至るまでの症候期間が永かつたため術後高血圧の非可逆化副腎皮質機能回復の遅延がみられた.早期手術が望まれた1例である.4)内分泌学的な考察副腎腫瘍の診断および手術に関する考按がなされた.稿を終えるにあたり恩師稲田教授および三宅教授の御懇篤な御指導と御校閲をいただいたことに対し深謝いたします.

A 37-year-old divorced female with Cushing's syndrome o f four years duration underwent exploration of adrenals on both sides. Preoperatively, it was expected that the patient had an adenoma of the adrenal gland because she showed normal urinary corticosteroids, minimal response to ACTH stimulation test and negative suppression test. Virological examination including retroperitoneal air study, however, could not disclose any distinct suprarenal mass. The left adrenal was first explored through a flank incision, but there was no tumor but an atrophied adrenal which was confirmed by biopsy study. The right side was then operated on, and a globular tumor was found arising from the adrenal, which was removed. It measured 3.2 x2.8x 2.0 cm. and weighed 7.5g. Pathohistologically it was proved to be benign adenoma containing abudant lipid as shown with Sudan III stain. Replacement therapy was started at the time of adrenal s u rgery and continued for two months with its dosis being gradually diminished, but she soon developed adrenal insufficiency manifested by anorexia, general malaise, nausea and low blood pressure. Prednisolone and 9a-Fluorohydrocortisone were immediately administered with rather prompt recovery. Postoperatively, moon-face, obesity, plethoric appearance, hirsutism, acne vulgaris, skin infection, hemorrhagic tendency and emotional instability disappeared. Edema on the lower extremities, however, persisted f or a long period, and osteoporosis is still present on X-ray though lumbar pain has much improved. She lost 10 kg. of w eight in 4 months. Blood pressure was rather unstable for 10 months postoperatively ranging 200/110 to 130/90, but it raised again to 200-230/100-130. This high blood pressure is thought to be of renal origin ; namely, one is pyelonephritis due to bilateral kidney stones caused by demineralisation in Cushing's syndrome and another is irreversible hypertensive kidae It was emphasized that a patient with Cushing's syndrome should have surgical treatment as soon as possible because it causes, if prolonged, various irreversible conditions. Endocrinological aspect of Cushing's syndrome was precisely discussed in this paper.