Abstract
Here, we report the cases of 2 patients with adrenocorticotropic hormone (ACTH) -independent macronodular adrenocortical hyperplasia (AIMAH) successfully treated with laparoscopic unilateral adrenalectomy. Case 1 : A 51-year-old man with treatment-resistant hypertension was diagnosed with AIMAH. Further examination revealed that the patient had preclinical Cushing's syndrome (PC), and unilateral right adrenalectomy was performed. Case 2 : A 61-year-old woman with early-onset hypertension from the age of 40 years was incidentally found to have AIMAH with PC, and unilateral right adrenalectomy was performed. The blood-pressure levels of the 2 patients improved, and serum levels of ACTH and cortisol became normalized after the operation. Conventionally, bilateral total adrenalectomy is the treatment of choice for a patient with AIMAH, although life-time steroid supplementation is required. The outcomes observed in our cases and in recent reports show that hemi-adrenalectomy is a safe and feasible alternative and should be considered as the standard surgical treatment for AIMAH patients to compensate for the critical demerit of bilateral total adrenalectomy.
