TITLE:
Possible Origin of Aldosteronoma from Adrenohepatic Fusion Resulting in Intrahepatic Tumor
AUTHORS:
Takumi Takeuchi, Takashi Inoue, Keiko Kanemoto, Kazuchika Hagiwara, Koji Mikami, Mami Hattori, Masayoshi Zaitsu, Akiko Tonooka, Toshimasa Uekusa, Susumu Uda
KEYWORDS:
Adrenal; Tumor; Adrenohepatic Fusion
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.6,
October
4,
2013
ABSTRACT:
A 69-year-old woman was diagnosed with primary
aldosteronism. An enhanced computed tomography (CT) scan before surgery
indicated a right adrenal tumor outside the liver. Venous sampling tests
revealed unilateral overproduction of aldosterone by the right adrenal gland. Separation
of the right adrenal cortex from the liver parenchyma was impractical during a
laparoscopic right adrenalectomy because of the solid attachment between the
two. Therefore, the existence of adrenohepatic fusion was determined. An
incision was made within the right adrenal gland, leaving completely the
intrahepatic adrenal tissue on the inner side of the liver, because a partial
hepatectomy was not preoperatively planned, and the patient was not informed of
the consent before the surgery. Pathological examination did not reveal macro-
or micro-adenomas in the resected right adrenal tissue. Aldosterone to renin
ratio was as high as 1380 at 22 days following the surgery. Therefore, aldosteronoma
originated from the adrenohepatic fusion that remained on the inner side of the
liver was highly suspected. The patient’s blood pressure was well controlled,
and she did not prefer hepatectomy to be further performed, and therefore,
medical therapy was continued. When planning the type of surgery (laparoscopic
or open) in these potentially confusing cases, it might be necessary to
consider a possibility of the unexpected intraoperative diagnosis and the immediate
measures to be performed based on the diagnosis.