両側副腎多発性腺腫によるクッシング症候群の1例

Abstract

45歳女.全身倦怠感, 口渇, 視力低下を主訴として入院, 糖尿病を指摘されており血圧194/100mmHg, 腹部CTで右副腎は雪だるま型, 左は球状に腫大, 副腎シンチグラムで両側副腎に集積がみられ, 両側副腎多発腺腫又は結節性過形成によるクッシング症候群と診断手術右副腎に黄褐色の腫瘤とblack adenomaの2種類と左副腎に黄褐色の腫瘤が認められた.high performance liquid chromatographyにて右のblack adenomaと左副腎腫瘍のコルチゾール, 11デオキシコルチゾール含量はもう一つの腫瘍及び左腫瘍周囲組織に比べて高かった.術後ハイドロコーチゾンの補充療法を行い, 術後ACTHは正常範囲となり, CRH負荷試験も正常範囲に回復した

We report a case of Cushing's syndrome due to bilateral adrenal adenomas. A 45-year-old woman was found to have Cushing's syndrome during the course of treatment for diabetes mellitus. The diagnosis of Cushing's syndrome was based on the absence of a diurnal rhythm in plasma cortisol and failure to suppress plasma cortisol by 1 or 4 mg of dexamethasone. The plasma level of adrenocorticotropic hormone (ACTH) was below the normal range, and plasma cortisol responded normally to rapid ACTH injection. Abdominal computed tomography revealed bilateral adrenal tumors. Bilateral uptake of radiocholesterol by the adrenal cortex was observed in adrenal scintigraphy. Bilateral adrenalectomy was performed. Microscopic examination and analysis of steroid contents by high performance liquid chromatography showed that the tumor was cortisol-producting adenoma.