Asymptomatic adrenal medullary hyperplasia detected with intraoperative hypertension : a case report

Abstract

41歳男性.患者は左側腹部痛を主訴に来院した.血圧や血中カテコラミン値は正常範囲であった.腹部エコー, CTスキャン, 血管造影で左腎腫瘍を認めたが, 副腎の形態には異常を認めなかった.左腎細胞癌の診断で根治的腎摘術を施行したところ, 腎摘中に著明な高血圧と頻脈を認めた.病理診断は腎細胞癌であったが, 同時に切除された同側副腎には副腎髄質過形成が認められた

We report a rare case of asymptomatic adrenal medullary hyperplasia detected by chance with intraoperative hypertension during surgery for ipsilateral renal cell carcinoma. A 41-year-old male visited our hospital with a complaint of left flank pain. He had normal blood pressure and plasma catecholamine level was within normal limits. Ultrasonogram and CT scan revealed a left renal tumor but did not showed any abnormal masses in the left adrenal gland. The clinical diagnosis was renal cell carcinoma and we performed left total nephrectomy. In the process of operative manipulation, however, the blood pressure and pulse rate of this patient showed a marked increase. Pathological examination of the extirpated kidney revealed renalcell carcinoma, while the resected adrenal gland was diagnosed as adrenal medullary hyperplasia.