副腎性高血圧症の手術経験

Abstract

The clinical experiences of adrenalectomy in the eleven c ases, in which adrenal hypertension was suspected, have been presented. In the two cases of Cushing's syndrome, symptoms were improved after removal of the left adrenal gland which was found to have adenomatous hyperplasia in one of them, and a complete recovery was obtained in the other one who had nodular hyperplasia of the adrenal gland which was subtotally removed. In the four cases of al d osteronism, two of them were primary and the others were secondary. One of the primary aldosteronism had adenoma and the other had adenomatous hyperplasia, and both of them were recovered after the left adrenalectomy. One of the secondary aldosteronism was possessed of diffuse hyperplasia and recovered by subtotal adrenalectomy. The other one of the secondary aldosteronism with chief complaints of hypertension and edema revealed micronodular hyperplasia of the zona glomerulosa and improved after the left adrenalectomy. In the three cases of clinically suspected pheochromocytoma, one of them was recovered following the left adrenalectomy. In the other two cases, however, no tumor was found in the surgical explorations. In the oth e r two cases of hypertension, the one revealed a histological picture of diffuse cortical hyperplasia and showed no clinical improvement following the left adrenalectomy. The other case, on the other hand, improvement of, clinical symptoms was achieved following the subtotal adrenalectomy, although no pathological change was found in the removed adrenal gland histologically. Bas e d on the experiences obtained from these eleven patients, discussions were made on the problems of diagnosis and treatment of the adrenal diseases particularly on the radiological examinations, surgical techniques and replacement therapy. Histochemical findings of the adrenal gland were also described in regard to the relationship between the clinical pictures and the hormonal secretory activities.