Abstract
A case of unilateral adrenocortical hyperplasia is presented. A 46-year-old woman with a 7-year history of hypertension and a 1-year-history of hypokalemia was diagnosed with primary aldosteronism. Computed tomography, magnetic resonance imaging, venous sampling and adosterol scintigraphy exhibited a functioning left adrenal mass. The plasma aldosterone concentration increased markedly when furosemide with upright posture and either captopril or adrenocorticotropin were administered. Plasma renin activity was suppressed below the detectable range. Aldosterone secretion displayed a circadian rhythm and was not suppressed by dexamethasone administration. The resected left adrenal mass was pathologically diagnosed as adrenocortical nodular hyperplasia. Unilateral adrenal hyperplasia involving the zona glomerulosa rarely has been reported, with varying and incompletely characterized hormonal characteristics. This case report and literature review suggest unilateral adrenal hyperplasia as a rare cause of hyperaldosteronism with characteristies intermediate between idiopathie hyperaldosteronism and aldosterone-producing adrenocortical adenoma, resembling the functional features of the adenoma more closely.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Weinberger M.H., Grim C.E., Hollifield J.W., Kern D.C., Ganguly A., Kramer N.J., Yune H.Y., Wellman H., Donohue J.P. Primary aldosteronism: diagnosis, localization and treatment. Ann. Intern. Med. 90: 386, 1979.
Ganguly A., Zager P.G., Luetscher J.A. Primary aldosteronism due to unilateral adrenal hyperplasia. J. Clin. Endocrinol. Metab. 51: 1190, 1980.
Gauguly A., Yum M.N., Pratt J.H., Weinberger M.H., Grim C.E., Yune H.Y., Donohue J.P. Unilateral hypersecretion of aldosterone associated with adrenal hyperplasia as a cause of primary aldosteronism. Clin. Exp. Hypertens. 5: 1635, 1983.
Mendlowitz M. A case of predominantly unilateral psudoprimary hyperaldosteronism. Mt. Sinai J. Med. 49: 76, 1982.
Oberfield S.E., Levine L.S., Firpo A., Lawrence D. Sr., Stoner E., Levy D.J., Sen S., New M.I. Primary hyperaldosteronism in childhood due to unilateral macronodular hyperplasia. Case report. Hypertension 6: 75, 1984.
Kern D.C., Tang K., Hanson C.S., Brown R.D., Painton R., Weinberger M.H., Hollifield J.W. The prediction of anatomical morphology of primary aldosteronism using serum 18-hydroxycorticosterone levels. J. Clin. Endocrinol. Metab. 60: 67, 1985.
Dye N.V., Litton N.J., Varma M., Isley W.L. Unilateral adrenal hyperplasia as a cause of primary aldosteronism. South Med. J. 82: 82, 1989.
Irony I., Kater C.E., Biglieri E.G., Shackleton C.H.L. Correctable subsets of primary aldosteronism: Primary adrenal hyperplasia and renin responsive adenoma. Am. J. Hypertens. 3: 576, 1990.
Kojima M., Masuda T. Idiopathic hyperaldosteronism. Unilateral idiopathic hyperaldosteronism in adults. Folia Endocrinol. 66: 796, 1990 (in Japanese).
Pignatelli D., Falcāo H., Coimbra-Peixoto A., Cruz F. Unilateral adrenal hyperplasia. South Med. J. 87: 664, 1994.
Matfin G., Ganguly A. Unilateral adrenal hyperplasia. South Med. J. 88: 377, 1995.
Watanabe Y., Fukuchi S. The long-term administration of dexamethasone for the differentiation of the 4 types of hyperaldosteronism. Folia Endocrinol. 71: 149, 1995 (in Japanese).
Bravo E.L., Tarazi R.C., Dustan H.P., Fouad F.M., Textor S.C., Gifford R.W., Vidt D.G. The changing clinical spectrum of primary aldosteronism. Am. J. Med. 74: 641, 1983.
Young W.F. Jr., Hogan M.J., Klee G.G., Grant C.S., Heerden J.A. Primary aldosteronism: Diagnosis and treatment. Mayo Clin. Proc. 65: 96, 1990.
Mantero F., Armanini D., Biason A., Boscaro M., Carpené G., Fallo F., Opocher G., Rocco S., Scaroni C., Sonino N. New aspects of mineralocorticoid hypertension. Horm. Res. 34: 175, 1990.
Kaplan N.M. Primary aldosteronism: In: Neal W.W., (eds.). Clinical hypertension. 6th ed. Williams and Wilkins, 1994, p. 389.
Neville A.M., O’Hare M.J. Histopathology of the human adrenal cortex. Clin. Endocrinol. Metab. 14: 791, 1985.
Ganguly A., Dowdy A.J., Luetscher J.A., Melada G.A. Anomalous postural response of plasma aldosterone concentration in patients with aldosterone-producing adrenal adenoma. J. Clin. Endocrinol. Metab. 36: 401, 1973.
Biglieri E.G., Schambelan M., Brust N., Chang B., Hogan M. Plasma aldosterone concentration: further characterization of aldosterone-producing adenomas. Cir. Res. 34(Suppl 1): 1183, 1974.
Biglieri E.G., Schambelan M. The significance of elevated levels of plasma 18-hydroxycorticosterone in patients with primary aldosteronism. J. Clin. Endocrinol. Metab. 49: 87, 1979.
Iwaoka T., Umeda T., Naomi S., Ohono M., Miura F., Sasaki M., Inoue J., Hamasaki S., Sato T. Lateralisation of aldosterone-producing adenoma in primary aldosteronism. Folia Endocrinol. 64: 1273, 1988 (in Japanese).
Ross E.J. Conn’s syndrome due to adrenal hyperplasia with hypertrophy of zona glomerulosa, relieved by unilateral adrenalectomy. Am. J. Med. 39: 994, 1965.
Kawasaki T., Omae T., Tanaka K., Matsunaga M., Emoto K. Remission of recurrent hyperaldosteronism resulting from subtotal adrenalectomy of adenomatous hyper-plastic adrenal glands. J. Clin. Endocrinol. Metab. 33: 474, 1971.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Otsuka, F., Otsuka-Misunaga, F., Koyama, S. et al. Hormonal characteristics of primary aldosteronism due to unilateral adrenal hyperplasia. J Endocrinol Invest 21, 531–536 (1998). https://doi.org/10.1007/BF03347340
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03347340