腎細胞癌と内分泌非活性副腎腺腫を合併した1例

Abstract

56歳男.血算, 血液生化学検査では空腹時血糖が軽度上昇していた以外に異常所見は認めず, 総腎機能は良好であった.尿細胞診はclass IIであった.内分泌学的検査所見では尿中アドレナリンが軽度上昇していたが, ノルアドレナリンは正常範囲であった.しかし, 血清コーチゾルの日内変動は消失していた.デキサメサゾン抑制試験では, 2mg二日間投与で抑制を認めた.造影CTでは左腎下極および左副腎に腫瘍を認めた.デキサメサゾン2mg抑制下131 Iアドステロールシンチでは左副腎のup takeが右副腎より明らかに高かった.左腎細胞癌および内分泌非活性副腎腺腫と診断し, 経腰的根治的左腎摘および左副腎全摘術を施行した.術後のホルモン検査ではコーチゾルの日内変動の回復を認めた.病理診断は, 左腎腫瘍はrenal cell carcinoma, 左副腎腫瘍は副腎皮質腺腫であった

Left renal and left adrenal masses were incidentally found by computerized tomography (CT) in a 56-year-old man who was admitted to our hospital for treatment of upper digestive tract hemorrhage. Apparently no clinical signs suggestive of Cushing's syndrome existed. The renal tumor was diagnosed as renal cell carcinoma based on the findings on enhanced CT. 131I-adosterol uptake in the examination of adrenal scintigraphy under dexamethasone suppression was definitely increased in the left adrenal gland, although hormonal examinations of serum and urine for adrenal functions were within the normal range. Plasma adrenocorticotropic hormone (ACTH) and serum cortisol were suppressed by administration of 2 mg dexamethasone for 2 days. The left kidney was radically removed by surgery together with the left adrenal gland. Histological diagnoses were left renal cell carcinoma and adrenocortical adenoma.