Bilateral Cortical-sparing Adrenalectomy for the Treatment of Bilateral Aldosterone-producing Adenomas

Abstract

Aldosterone-producing adenoma (APA) is 1 of the major subtypes of primary aldosteronism (PA). Although most APA occurs unilaterally, bilateral APAs have rarely been documented. Because of its rarity, optimal management of patients with bilateral APAs has not been established. Here, we report a case of bilateral APAs that was successfully treated with simultaneous bilateral cortical-sparing surgery. A 44-year-old Japanese woman was referred to us for the evaluation of PA. She had typical clinical characteristics of PA, including hypertension, hypokalemia, and high plasma aldosterone concentration with suppressed renin. She was diagnosed as having PA based on the results of confirmatory testing. Computed tomography revealed bilateral adrenal nodules with diameters of 17 and 10 mm on the right and left adrenal gland, respectively. Adrenal venous sampling indicated excess aldosterone production from bilateral adrenal lesions. She underwent simultaneous bilateral laparoscopic partial adrenalectomy that normalized her blood pressure and serum potassium levels. Aldosterone synthase immunohistochemistry on the resected adrenal tumor tissue confirmed the diagnosis of bilateral APAs. Long-term postsurgical follow-up data suggest cure of the disease without the need for glucocorticoid replacement therapy. Bilateral cortical-sparing adrenalectomy appears to be a viable treatment option at least for selected patients with bilateral APAs.

Keywords: CYP11B2; bilateral aldosterone-producing adenomas; cortical-sparing adrenalectomy; primary aldosteronism.

Figure 1.

Results of adrenal computed tomography. (A and B) Representative images of contrast-enhanced adrenal CT scan. Red arrows indicate adrenal tumors (A, Right adrenal tumor. B, Left adrenal tumor). CT, computed tomography.

Figure 2.

Histologic findings of the resected adrenal tumors. (A-D) Histologic findings of right adrenal tumor. (E-H) Histologic findings of left adrenal tumor. (A and E) Cut surfaces of the resected adrenal tumors. (B and F) Hematoxylin and eosin staining. (C and G) CYP11B2 immunohistochemistry. (D and H) CYP11B1 immunohistochemistry.