Tohoku J. Exp. Med., 2021 February, 253(2)

The Potential of Computed Tomography Volumetry for the Surgical Treatment in Bilateral Macronodular Adrenal Hyperplasia: A Case Report

Hiromu Matsunaga,¹ Yuta Tezuka,¹ Tomo Kinoshita,² Hiroko Ogata,³ Yuto Yamazaki,³ Beata Shiratori,¹ Kei Omata,¹ Yoshikiyo Ono,¹ Ryo Morimoto,¹ Masataka Kudo,¹ Kazumasa Seiji,² Kei Takase,² Yoshihide Kawasaki,⁴ Akihiro Ito,⁴ Hironobu Sasano,³ Hideo Harigae¹ and Fumitoshi Satoh^1,5

¹Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
²Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
³Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
⁴Department of Urology, Tohoku University Hospital, Sendai, Miyagi, Japan
⁵Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

Although adrenal resection is a major option to control hypercortisolemia in patients with bilateral macronodular adrenal hyperplasia, a predictive method for postoperative cortisol production has not been established. A 53-year-old man with ulcerative colitis was referred to our hospital for bilateral multiple adrenal nodules and hypertension. Physical and endocrinological examination revealed inappropriate cortisol production and suppressed secretion of adrenocorticotropic hormone with no typical signs of Cushing�fs syndrome. Imaging analysis revealed bilateral adrenal nodular enlargement, the nodules of which had the radiological features of adrenocortical adenomas without inter-nodular heterogeneity. In addition, computed tomography volumetry demonstrated that the left adrenal gland (70 mL) accounts for three quarters of the total adrenal volume (93 mL). The patient was diagnosed as subclinical Cushing�fs syndrome due to bilateral macronodular adrenal hyperplasia, and subsequently underwent a left laparoscopic adrenalectomy with the estimation of 75% decrease in the cortisol level based on the adrenal volume. The surgical treatment ultimately resulted in control of the cortisol level within the normal range, which was compatible to our preoperative prediction. However, regardless of the sufficient cortisol level, ulcerative colitis was exacerbated after the surgery, which needed a systemic therapy for remission. This case indicates successful surgical control of hypercortisolemia based on computed tomography volumetry in bilateral macronodular adrenal hyperplasia, as well as the perioperative exacerbation risk for inflammatory diseases in Cushing�fs syndrome. We report the potential utility of computed tomography volumetry as a quantitative method with retrospective evaluation of our historical cases.

Keywords —— bilateral macronodular adrenal hyperplasia; computed tomography volumetry; Cushing�fs syndrome; hypertension; ulcerative colitis

© 2021 Tohoku University Medical Press

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Tohoku J. Exp. Med 2021 February, 253(2), 143-150.

Correspondence: Fumitoshi Satoh M.D., Ph.D., Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.

e-mail: fsatoh@med.tohoku.ac.jp