A case of bilateral XXXX -producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery.

@entity1 @entity20805 @entity1369 @entity101 @entity5 @entity916 @entity1368
UNASSIGNED: @entity1368 due to unilateral @entity1369 -producing adenoma (APA) is a surgically curable form of @entity101 . Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral @entity1368 ( @entity1368 ) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old @entity1 with marked long-standing @entity101 was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked @entity101 , hypokalaemia, elevated plasma @entity1369 concentration (PAC) of 45.1   ng   dl(-1) and @entity1369 @entity916 activity ratio of 90.2 (ng   dl(-1) per ng   ml(-1   )h(-1)), which was still high after 50   mg- @entity20805 loading. CT revealed @entity5 of 10 and 12   mm in diameter on the right and left sides, respectively. S-AVS confirmed excess @entity1369 secretion from a @entity5 segment vein and suppressed secretion from a @entity5 segment vein bilaterally, leading to the diagnosis of bilateral APA. The @entity1 underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2   ng   dl(-1) confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from @entity1368 by direct evaluation of intra-adrenal hormone production.Journal of @entity1 @entity101 advance online publication, 5 November 2015; doi:10.1038/jhh.2015.100.
