Usefulness and Limitations of Unilateral Adrenalectomy for ACTH-independent Macronodular Adrenal Hyperplasia in a Patient with Poor Glycemic Control

Takaaki Kobayashi; Takashi Miwa; Kenshi Kan; Misato Takeda; Hiroyuki Sakai; Akira Kanazawa; Akihiko Tanaka; Kazunori Namiki; Toshitaka Nagao; Masato Odawara

doi:10.2169/internalmedicine.51.7041

CASE REPORTS

Usefulness and Limitations of Unilateral Adrenalectomy for ACTH-independent Macronodular Adrenal Hyperplasia in a Patient with Poor Glycemic Control

Takaaki Kobayashi, Takashi Miwa, Kenshi Kan, Misato Takeda, Hiroyuki Sakai, Akira Kanazawa, Akihiko Tanaka, Kazunori Namiki, Toshitaka Nagao, Masato Odawara

Author information

Takaaki Kobayashi
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Takashi Miwa
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Kenshi Kan
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Misato Takeda
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Hiroyuki Sakai
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Akira Kanazawa
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan
Akihiko Tanaka
Internal Medicine, Toda Chuo General Hospital, Japan
Kazunori Namiki
Department of Urology, Tokyo Medical University, Japan
Toshitaka Nagao
Department of Pathology, Tokyo Medical University, Japan
Masato Odawara
Division of Diabetes, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Japan

Keywords: ACTH-independent macronodular adrenal hyperplasia, Cushing's syndrome

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 13 Pages 1709-1713

DOI https://doi.org/10.2169/internalmedicine.51.7041

Details

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.

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