Coincidence of Large Adrenal Cyst and Prominent Hyporeninemic Hyperaldosteronism

Hiromi Iwahashi,Yuto Yamazaki,Maeda Norikazu,Junji Kozawa,Hironobu Sasano,Taka-Aki Matsuoka,Takaaki Sakaue,Yosuke Okuno,Hitoshi Nishizawa,Shingo Fujita,Michio Otsuki,Mihail A Boyanov,Kosuke Mukai,Iichiro Shimomura

doi:10.1155/2021/8860498

Hiromi Iwahashi, Yuto Yamazaki + Show 12 more

Open Access

https://doi.org/10.1155/2021/8860498

Copy DOI

Abstract

A 67-year-old Japanese woman who had end-stage renal disease was referred to our hospital for kidney transplantation. Abdominal CT revealed a large adrenal mass with inhomogeneity. She had a history of hospitalization for stroke and heart failure and exhibited prominent hyporeninemic hyperaldosteronism. Histological examination of the resected tumor with anti-CYP11B2 antibody indicated that she had a vascular endothelial cyst with primary aldosteronism (PA) due to multiple adrenocortical micronodules. This report implicates the pathological interaction between adrenal vascular cysts and PA-mediated vascular damage of the adrenal vein.

Highlights

Adrenal cysts are rare and form a heterogeneous group of lesions. eir incidence in autopsy has been reported to be 0.064–0.18% [1]
We report the unique case of prominent hyporeninemic hyperaldosteronism with a large vascular endothelial cyst. e coincidence of hyporeninemic hyperaldosteronism and adrenal cyst was reported only in one case report, where primary aldosteronism (PA) by adrenal adenoma was combined with ipsilateral pseudocyst [5]
E cause of adrenal vascular endothelial cysts and pseudocysts is not clear, but they are considered to originate from prior hemorrhage from pre-existing vascular hamartoma or adrenal vein [3, 6]

Summary

Introduction

Adrenal cysts are rare and form a heterogeneous group of lesions. eir incidence in autopsy has been reported to be 0.064–0.18% [1]. A 67-year-old Japanese woman was referred to our hospital for renal replacement therapy and kidney transplantation She had been diagnosed as hypertension at her late 20s, but blood pressure was poorly controlled despite treatment with antihypertensive drugs without an aldosterone antagonist. During the checkup for kidney transplantation, abdominal CT revealed a left adrenal mass, which was 5 cm in diameter with inhomogeneity of density and smooth borders (Figure 1(a)) She was admitted in August 2018 for endocrinological examination. Her serum potassium level was at the lower limit of normal despite ESRD. On the positron emission tomography with fluorodeoxyglucose (FDG-PET), the mass

Diurnal profile of ACTH and cortisol

Discussion

Adrenal gland PDPN