Document Detail

A case of severe hypertension caused by ACTH-independent macronodular adrenal hyperplasia.
MedLine Citation:
PMID:  11936469     Owner:  NLM     Status:  MEDLINE    
This report describes a rare case of ACTH-independent macronodular adrenal hyperplasia (AIMAH) arisen with symptomatic severe hypertension and hypokaliemia. A 55-year-old man was admitted to hospital with a clinical picture characterized by several episodes of transient ischemic attacks (TIA) and right hemiplegia, related to severe arterial hypertension. Laboratory tests showed urinary levels of catecholamines, metanephrines and vanillylmandelic acid (VMA) in normal range; high urinary free cortisol excretion, elevated serum cortisol with loss of the circadian rhythm and low ACTH plasma levels. ACTH failed to respond to CRH administration. Serum cortisol levels were not modified after high doses of dexamethasone. MRI showed bilateral macronodular hyperplasia of adrenal glands, whereas pituitary-MRI did not show tumoral lesions. Therefore, ACTH-independent macronodular hyperplasia was suspected. Though obese, the patient had no typical Cushing habit, and symptomatic hypertension with hypokaliemia was the only clinical evidence for this rare kind of Cushing's syndrome. After obtaining a satisfactory control of blood pressure, the patient was successfully submitted to laparoscopic bilateral adrenalectomy and underwent complete clinical remission. The histology showed adrenal macronodular hyperplasia. During the twenty-four month follow-up, the patient had no further transient ischemic attacks or need of glucocorticoid replacement therapy and withdrew the antihypertensive drugs.
R Nocente; Marinis L De; A Mancini; A Bianchi; R Bellantone; L Lauriola; M Costanzo; Crea C De; G Gasbarrini; Silveri N Gentiloni
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of endocrinological investigation     Volume:  25     ISSN:  0391-4097     ISO Abbreviation:  J. Endocrinol. Invest.     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-04-08     Completed Date:  2002-09-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7806594     Medline TA:  J Endocrinol Invest     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  254-8     Citation Subset:  IM    
Institute of Internal Medicine, Catholic University of Rome, Italy.
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MeSH Terms
Adrenal Glands / pathology*
Adrenocorticotropic Hormone / blood*
Catecholamines / urine
Circadian Rhythm
Corticotropin-Releasing Hormone / diagnostic use
Cushing Syndrome / etiology,  pathology,  therapy
Hemiplegia / etiology
Hydrocortisone / blood,  urine
Hypertension / etiology*
Hypokalemia / complications
Ischemic Attack, Transient / etiology
Magnetic Resonance Imaging
Metanephrine / urine
Middle Aged
Obesity / complications
Pituitary Gland / pathology
Remission Induction
Vanilmandelic Acid / urine
Reg. No./Substance:
0/Catecholamines; 50-23-7/Hydrocortisone; 5001-33-2/Metanephrine; 55-10-7/Vanilmandelic Acid; 9002-60-2/Adrenocorticotropic Hormone; 9015-71-8/Corticotropin-Releasing Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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