Abstract
A rare case of primary aldosteronism with two clear cell adnomas and one black adenoma in the left adrenal gland is reported. All of these adenomas were almost the same size about 10 mm in diameter.
A 50-year-old woman was admitted to our hospital complaining of hypertension, hypokalemia (3.2 mEq/l) and hyperglycemia. Plasma aldosterone level was high (280 pg/ml), while renin activity was suppressed (0.1 ng/ml/h). Plasma cortisol level was normal high (18.8μg/dl) and urinary 17-OHCS was within normal range. Abdominal CT revealed a left adrenal tumor.
The left adrenal gland was completely removed. There were two clear cell adenomas and one black adenoma. There were 20 percent compact cells in one of the clear cell adenomas, while the other consisted with only clear cells. Black adenoma consisted of eosinophilic cells with infltration of lipofustin granules.
Immunohistochemical analysis was done on each adenoma and the adjacent adrenal tissue. P450-SCC, 3βHSD, P450-C21, C11, C17 and DHEA-ST were all detected in the black adenoma, while P450-C17 and DHEA-ST were not present in the clear cell adenomas. DHEA-ST was suppressed in the adjacent adrenal tissue.
It is suggested that excessive aldosterone was secreted autonomously in only the the clear cell adenoma accompanying compact cells, and that the other adenomas were non-functioning.
