Usefulness and limitations of unilateral adrenalectomy for ACTH-independent macronodular adrenal hyperplasia in a patient with poor glycemic control.

Abstract

Adrenocorticotropic hormone (ACTH)-independent macronodular adrenal hyperplasia (AIMAH) is a rare disease which causes Cushing's syndrome. Bilateral adrenalectomy has been recommended as the treatment of choice for AIMAH. However, bilaterally adrenalectomized patients require lifelong steroid replacement therapy. Therefore, an increasing number of patients have undergone unilateral adrenalectomy for AIMAH. We report a case of AIMAH due to refractory diabetes in whom unilateral adrenalectomy initially yielded good diabetes control, but in whom poor glycemic control developed after 5 years, requiring eventual additional contralateral adrenalectomy. In elderly patients with AIMAH, one-stage bilateral adrenalectomy may be the treatment of choice.

• Authors: Takaaki Kobayashi, Takashi Miwa, Kenshi Kan, Misato Takeda, Hiroyuki Sakai, Akira Kanazawa, Akihiko Tanaka, Kazunori Namiki, Toshitaka Nagao, Masato Odawara
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 51 Issue 13 Pg. 1709-13 ( 2012) ISSN: 1349-7235 [Electronic] Japan
• PMID: 22790131 (Publication Type: Case Reports, Journal Article)

Chemical References

• Blood Glucose
• Adrenocorticotropic Hormone

Topics

• Adrenal Glands (diagnostic imaging, pathology, physiopathology, surgery)
• Adrenalectomy (methods)
• Adrenocorticotropic Hormone (metabolism)
• Aged
• Blood Glucose (metabolism)
• Cushing Syndrome (diagnostic imaging, etiology, physiopathology, surgery)
• Diabetes Complications (physiopathology)
• Female
• Humans
• Hyperplasia
• Tomography, X-Ray Computed