腎上腺靜脈取樣在庫欣氏症候群合併雙側腎上腺腫瘤的應用及病例報告

謝棨圳 1, 李經家 1,2,3

1 高雄醫學大學附設中和紀念醫院泌尿部

2 高雄醫學大學醫學院臨床醫學研究所

3 高雄醫學大學醫學院醫學系泌尿學科

The Application of Adrenal Vein Sampling in Cushing Syndrome with Bilateral Adrenal Tumors: A Case Report

Chi-Chun Hsieh¹, Ching‑Chia Li^1,2,3

¹Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

²Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

³Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract Background

Cushing syndrome, a condition of overproduction of glucocorticoids by adrenal cortex is a rare disease with incidence around 2 to 5 of every 1 million people per year. The mechanism of Cushing syndrome include: exogenous, ACTH dependent, and adrenocorticotropic hormone (ACTH) independent. Cortisol-secreting adrenal adenoma accounts for 10% of Cushing syndrome, with mostly unilateral hyperplastic nodule. Multifocal and bilateral adrenal tumor stand less than ten percent and pose challenge to diagnosis and treatment, not to mention the worrying risk after bilateral adrenalectomy. We present one case of Cushing syndrome with bilateral adrenal

tumor receiving unilateral adrenalectomy after adrenal vein sampling (AVS) lateralization.

Case Presentation

A 66-year-old female with underlying disease of Type 2 DM (diabetes mellitus), hypertension, dyslipidemia and atrial fibrillation. She complained lower limbs weakness for months and she received abdominal computed tomography, which showed bilateral adrenal tumors (right: 4.6cm, left: 3.9cm). She had central obesity, moon face and buffalo hump in appearance.

She received laparoscopic left adrenalectomy smoothly without acute complication was noted.

Conclusion

For Cushing syndrome patients with bilateral adrenal tumor, bilateral