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Analysis of Unilateral Adrenal Hyperplasia with Primary Aldosteronism from the Aspect of Messenger Ribonucleic Acid Expression for Steroidogenic Enzymes: A Comparative Study with Adrenal Cortices Adhering to Aldosterone-Producing Adenoma

Divisions of Pathology (K.Shig.) and Nephro-Urology (H.S.), Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; Division of Pathology (K.K., J.I.) Nagasaki Municipal Hospital, Nagasaki 850-8555, Japan; Division of Pathology (O.N.) and Urology (A.I.), National Hospital Organization Kyushu Medical Center, Fukuoka 812-8582, Japan; Division of Cardiovascular Internal Medicine (J.S.), Fukuoka City Medical Association Hospital, Fukuoka, 814-8522, Japan; Yame General Hospital (K.Shim.), Fukuoka 834-0034, Japan; and Divison of Urology (Y.K.) and Pathology (O.T.), Japanese Red-Cross Nagasaki Atomic Bomb Hospital, Nagasaki 852-8511, Japan

Address all correspondence and requests for reprints to: Kazuto Shigematsu, Division of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 12-4, 1-chome, Sakamoto, Nagasaki 852-8523, Japan. E-mail: shigek{at}net.nagasaki-u.ac.jp.

Unilateral adrenal hyperplasia with primary aldosteronism is very rare and shows similar endocrine features to aldosterone-producing adenoma and bilateral adrenal hyperplasia. In this study, the mRNA expression of steroidogenic enzymes in unilateral adrenal hyperplasia was examined by in situ hybridization. We found subcapsular micronodules composed of spironolactone body-containing cells, which showed intense expression for 3ß-hydroxysteroid dehydrogenase, 11ß-hydroxylase, 18-hydroxylase, and 21-hydroxylase but not 17-hydroxylase, indicating aldosterone production. This expression pattern was the same as that in unilateral multiple adrenocortical micronodules, reported recently. Additionally, it was noted that a nodule with active aldosterone production was closely adjacent to one showing intense 17-hydroxylase expression. In the adrenal cortices adhering to aldosterone-producing adenoma, the majority of hyperplastic zona glomerulosa and hyperplastic nodules demonstrated a decreased steroidogenic activity. However, minute nodules indicative of active aldosterone production were found at high frequency. These results suggest that the subcapsular micronodules observed might be the root of aldosterone-producing adenoma. Furthermore, we emphasize the need for long-term follow-up after unilateral adrenalectomy or enucleation of the adenoma because of the possibility that buds with autonomous aldosterone production may still be present in the contralateral or remaining adrenal tissue.

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