OJU  Vol.3 No.6 , October 2013
Possible Origin of Aldosteronoma from Adrenohepatic Fusion Resulting in Intrahepatic Tumor
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.
Cite this paper: T. Takeuchi, T. Inoue, K. Kanemoto, K. Hagiwara, K. Mikami, M. Hattori, M. Zaitsu, A. Tonooka, T. Uekusa and S. Uda, "Possible Origin of Aldosteronoma from Adrenohepatic Fusion Resulting in Intrahepatic Tumor," Open Journal of Urology, Vol. 3 No. 6, 2013, pp. 223-226. doi: 10.4236/oju.2013.36042.

[1]   G. P. Rossi, “A Comprehensive Review of the Clinical Aspects of Primary Aldosteronism,” Nature Reviews Endocrinology, Vol. 7, No. 8, 2011, pp. 485-495.

[2]   M. Salvà, M. V. Cicala and F. Mantero, “Primary Aldosteronism: The Role of Confirmatory Tests,” Hormone and Metabolic Research, Vol. 44, No. 3, 2012, pp. 177-180.

[3]   P. Mulatero, S. Monticone, C. Bertello, G. Mengozzi, D. Tizzani, A. Iannaccone and F. Veglio, “Confirmatory Tests in the Diagnosis of Primary Aldosteronism,” Hormone and Metabolic Research, Vol. 42, No. 6, 2010,pp. 406-410.

[4]   O. Steichen, F. Zinzindohoué, P. F. Plouin and L. Amar, “Outcomes of Adrenalectomy in Patients with Unilateral Primary Aldosteronism: A Review,” Hormone and Metabolic Research, Vol. 44, No. 3, 2012, pp. 221-227.

[5]   L. H. Honoré and K. E. O’Hara, “Combined Adrenorenal Fusion and Adrenohepatic Adhesion: A Case Report with Review of the Literature and Discussion of Pathogenesis,” Journal of Urology, Vol. 115, No. 3, 1976, pp. 323-325.

[6]   R. Chamanza, H. A. Marxfeld, A. I. Blanco, S. W. Naylor and A. E. Bradley, “Incidences and Range of Spontaneous Findings in Control Cynomolgus Monkeys (Macaca fascicularis) Used in Toxicity Studies,” Journal of Toxicologic Pathology, Vol. 38, No. 4, 2010, pp. 642-657.

[7]   O. Quesada-Canales, A. Suárez-Bonnet, G. A. Ramírez, M. Aguirre-Sanceledonio, M. Andrada, M. Rivero and A. Espinosa de Los Monteros, “Adrenohepatic Fusion in Domestic Ferrets (Mustela putorius furo),”Journal of Comparative Pathology, Vol. 149, No. 2-3, 2013, pp. 314-317. j.jcpa.2013.02.003

[8]   S. Iwamoto, K. Okuda, N. Takeda, K. Sonoda and H. Sanefuji, “Case Report: Right-Sided Periadrenal Metastasis Supplied by the Hepatic Artery. Clue to the Genesis of Pedunculated Hepatocellular Carcinoma,” Journal of Gastroenterology and Hepatology, Vol. 12, No. 5, 1997, pp. 392-397.

[9]   K. Okuda, M. Arakawa, Y. Kubo, K. Sakata, M. Kage, S. Iwamoto, S. Takeda, K. Sonoda and H. Sanefuji, “Right-Sided Pedunculated Hepatocellular Carcinoma: A Form of Adrenal Metastasis,” Hepatology, Vol. 27, No. 1, 1998, pp. 81-85.

[10]   K. Okano, H. Usuki and H. Maeta, “Adrenal Metastasis from Hepatocellular Carcinoma through an ADRENOHEPATIC Fusion,” Journal of Clinical Gastroenterology, Vol. 38, No. 10, 2004, p. 912.

[11]   H. S. Woo, K. H. Lee, S. Y. Park, H. S. Han, C. J. Yoon and Y. H. Kim, “Adrenal Cortical Adenoma in Adrenohepatic Fusion Tissue: A Mimic of Malignant Hepatic Tumor at CT,” American Journal of Roentgenology, Vol. 188, No. 3, 2007, pp. W246-W248.

[12]   B. K. Park, C. K. Kim, B. C. Jung and Y. L. Suh, “Cortical Adenoma in Adrenohepatic Fusion Tissue: Clue to Making a Correct Diagnosis at Preoperative Computed Tomography Examination,” European Urology, Vol. 56, No. 6, 2009, pp. 1082-1085.

[13]   T. D. Barwick, A. Malhotra, J. A. Webb, M. O. Savage and R. H. Reznek, “Embryology of the Adrenal Glands and Its Relevance to Diagnostic Imaging,” Clinical Radiology, Vol. 60, No. 9, 2005, pp. 953-959.

[14]   Y. M. Shin, “Hepatic Adrenal Rest Tumor Mimicking Hepatocellular Carcinoma,” Korean Journal of Hepatology, Vol. 16, No. 3, 2010, pp. 338-341.

[15]   Y. Baba, T. Beppu, K. Imai, T. Masuda, K. Iyama, H. Sasano and H. Baba, “A Case of Adrenal Rest Tumor of the Liver: Radiological Imaging and Immunohistochemical Study of Steroidogenic Enzymes,” Hepatology Research, Vol. 38, No. 11, 2008, pp. 1154-1158.

[16]   K. Arai, H. Muro, M. Suzuki, N. Oba, K. Ito and H. Sasano, “Adrenal Rest Tumor of the Liver: A Case Report with Immunohistochemical Investigation of Steroidogenesis,” Pathology International, Vol. 50, No. 3, 2000, pp. 244-248.

[17]   P. Contreras, E. Altieri, C. Liberman, A. Gac, A. Rojas, A. Ibarra, M. Ravanal, M. Serón-Ferré, “Adrenal Rest Tumor of the Liver Causing Cushing’s Syndrome: Therapy with Ketoconazole Preceding an Apparent Surgical Cure,” The Journal of Clinical Endocrinology & Metabolism, Vol. 60, No. 1, 1985, pp. 21-28.

[18]   E. Z. Wallace, J. R. Leonidas, A. E. Stanek and A. Avramides, “Endocrine Studies in a Patient with Functioning Adrenal Rest Tumor of the Liver,” American Journal of Medicine, Vol. 70, No. 5, 1981, pp. 1122-1125.