対側副腎にホルモン非活性皮質腺腫を伴った褐色細胞腫の1例

Abstract

症例は59歳男性.近医にて糖尿病と診断され食療法, 薬物療法を受けた.MRI, CTで非対称性の副腎腫大を呈し, 静脈サンプリングにて両側副腎静脈のカテコールアミン値が高値であったため両側副腎の褐色細胞腫を疑い, 手術目的で入院した.全身麻酔下で両側副腎摘除術を施行した.その結果, 右側が褐色細胞腫, 左側がホルモン非活性副腎皮質腺腫であった.術後, hydrocortisoneのホルモン補充を開始した.術後も糖尿病の病態に変化は認められなかった.経過は順調で退院した.現在, 糖尿病の管理と共に経過観察中である

A case of a pheochromocytoma in the right adrenal gland and adrenocortical adenoma in the left adrenal gland of a 58-year-old male is reported. The patient was incidentally found to have a right adrenal tumor by ultrasonographic study. A computerized tomographic (CT) study and magnetic resonance image (MRI) study revealed bilateral adrenal tumors. The sizes of the right tumor and left tumor were 2.5 x 3.5 cm and 1.2 x 1.0 cm, respectively. The intensity of each tumor was different on T2-weighted MRI. 131I-MIBG scintigram showed the uptake of right adrenal gland. The existence of pheochromocytoma was confirmed by the elevated levels of catecholamines. We performed venous sampling to be certain whether the patient had unilateral or bilateral pheochromocytoma. As a result, bilateral adrenal pheochromocytoma was diagnosed. Therefore, we performed bilateral adrenalectomy. However, histopathological examination revealed right pheochromocytoma and left non-functioning adrenocortical adenoma.