ABSTRACT Two patients had a long history of hypertension and one of them also had a nephrotic-range proteinuria secondary to focal segmental scleronephrosis which had been diagnosed by kidney biopsy. They presented with uncontrolled hypertension. Laboratory examination suggested hypersecretion of catecholamines by the left adrenal glands in both patients and primary aldosteronism in one of them. A computed tomography scan revealed small nodules on left adrenal gland in both patients. Patients underwent laparoscopic left adrenalectomy. After surgery, blood pressure was normalized and proteinuria was resolved. Most interestingly, prominent adipocytes infiltrated were detected in the adrenal cortex and were associated with the presence of lymphocytes, which suggested that adipocytes might have a role in the pathogenesis of these diseases in our patients.
Cite this paper
nullK. Luong, L. Nguyễn, S. Nguyễn and N. Nguyễn, "Coexistence of the Hypersecretion of Catecholamine, Adrenal Cortical Nodular Hyperplasia, and Nephrotic-Range Proteinuria of Focal Segmental Scleronephrosis: Is It Fat-Induced Hypertension?," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 206-211. doi: 10.4236/ijcm.2011.23034.
 Park YK, Kim YW, Kim JW, Choi YK, Ko YT, Ko SW, and Yang MH. Bilateral primary pigmented nodular adrenocortical disease—A case report describing a rare cause of Cushing’s Syndrome. J Korean Med Sciences. Vol. 9, No. 6, 1994, pp. 450-457.
 Boyanton Jr BL, Hampel O, and Ostrowski ML. A 55-year-ol man with a rib fracture. Arch Pathol Lab Med. Vol. 130, No. 1, 2006, pp. e13-e14.
 Ajmi TS, Chaieb CM, Mokni M, Braham R, Ach K, Maaroufi A, and Chaieb L. Corticomedullary mixed tumor of the adrenal gland. Ann Endocrinol (Paris). Vol. 70, No. 6, 2009, pp. 473-476.
 Luong KVQ and Nguyen LTH. Coexistence of primary aldosteronism and pheochromocytoma in a Vietnamese patient. The Endocrinologist. Vol 6, No. 6, 1996, pp. 490-493.
 Weisberg SP, McCann D, Desai M, Rosebaum M, Leibel RL, and Ferrante Jr AW. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. Vol. 112, No. 12, 2003, pp. 1796-1808.
 Cancello R, Henegar C, Viguerie N, Taleb S, Poitu C, Rouault C, Coupaye M, Pelloux V, Hugol D, Bouillot JC, Bouloumié A, Barbatelli G, Cinti S, Svensson PA, Barsh GS, Zucker JD, Basdevant A, Langin D, and Clément K. Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes. Vol. 54, No. 8, 2005, pp. 2277-2286.
 Sartipy P and Loskutoff DJ. Monocyte chemoattractant protein 1 in obesity and insulin resistance. Proc Natl Acad Sci U.S.A. Vol. 100, No. 12, 2003, pp. 7265-7270.
 Bruun JM, Lihn AS, Pedersen SB, and Richelsen B. Monocyte chemoattractant protein-1 release is higher in visceral than subcutaneous human adipose tissue (AT): Implication of macrophages resident in the AT. J Clin Endocrinol Metab. Vol. 90, No. 4, 2005, pp. 2282-2289.
 Massiéra F, Bloch-Faure M, Ceiler D, Murakami K, Fukamizu A, Gasc JM, Quignard-Boulangé A, Negrel R, Ailhaud G, Seydoux J, Meneton P, and Teboul M. Adipose angiotensinogen is involved in adipose tissue growth and blood regulation. FASEB J. Vol. 15, No. 14, 2001, pp. 2727-2729.
 Giacchetti G, Faloi E, Mariniello B, Sardu C, Gatti C, Camilloni MA, Guerrieri M, and Mantero F. Overexpression of the renin-angiotensin system in human visceral adipose tissue in normal and overweight subjects. Am J Hypertens. Vol. 15, No. 5, 2002, pp. 381-388.
 Cooper R, McFarlane-Andersen N, Bennett FI, Wilks R, Puras A, Tewksburry D, Ward R, and Forrester T. ACE, angiotensinogen and obesity: A potential pathway leading to hypertension. J Hum Hypertens. Vol. 11, No. 2, 1997, pp. 107-111.
 Goodfriend TL, Egan BM, and Kelley DE. Aldosterone in obesity. Endocr Res. Vol. 24, No. 3-4, 1998, pp. 789-796.
 Tuck ML, Sowers J, Dornfeld L, Kledzik G, and Maxwell M. The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. N Engl J Med. Vol. 304, No. 16, 1981, pp. 930-933.
 Engeli S, B?hnke J, Gorzelniak K, Janke J, Schling P, Bader M, Luft FC, and Sharma AM. Weight loss and the renin-angiotensin-aldosterone system. Hypertension. Vol. 45, No. 3, 2005, pp. 356-362.
 Ehrhart-Bornstein M, Lamounier-Zepter V, Schraven A, Langenbach J, Willenberg HS, Barthel A, Hauner H, McCann SM, Scherbaum WA, and Bornstein SR. Human adipocytes secrete mineralocorticoid-releasing factors. PNAS. Vol. 100, No. 24, 2003, pp. 14211-14216.
 Goodfriend TL, Ball DL, Egan BM, Campbell WB, and Nithipatikom K. Epoxy-keto derivative of linoleic acid stimulates aldosterone secretion. Hypertension. Vol. 43, No. 2, 2004, pp. 358-363.
 Schinner S, Willenberg HS, Krause D, Schott M, Lamounier-Zepter V, Krug AW, Ehrhart-Bornstein M, Bornstein M, Bornstein SR, and Scherbaum WA. Adipocyte-derived products include the transcription of the StAR promoter and stimulate aldosterone and cortisol secretion from adrenocortical cells through the Wnt-signaling pathway. Int J Obes. Vol. 31, No. 5, 2007, pp. 864-870.
 Masuo K, Kawaguchi H, Mikami H, Orihara T, and Tuck ML. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension. Vol. 42, No. 4, 2003, pp. 474-480.
 Ahima RS and Flier JS. Leptin. Annu Rev Physiol. Vol. 62, 2000, pp. 413-437.
 Eikelis N, Lambert G, Wiesner G, Kaye D, Schlaich M, Morris M, Hastings J, Socratous F, and Esler M. Extra-adipocyte leptin release in human obvesity and its relation to symphoadrenal function. Am J Physiol Endocrinol Metab. Vol. 286, No. 5, 2004, pp. E744-E752.
 Glasow A, Haidan A, Hilbers U, Breidert M, Gillespie J, Scherbaum WA, Chrousos GP, and Bornstein SR. Expression of Ob receptor in normal human adrenals: Differential regulation of adrenocortical and adrenomedullary function by leptin. J Clin Endocrinol Metab. Vol. 83, No. 12, 1998, pp. 4459-4466.
 Takekoshi K, Motooka M, Isobe K, Normura F, Manmoku T, Ishii K, and Nakai T. Leptin directly stimulates catecholamin secretion and synthesis in cultured porcine adrenal medullary chromaffin cells. Biochem Biophys Res Comm. Vol. 261, No. 2, 1999, pp. 426-431.
 Weisinger JR, Kempson RL, Eldridge L, and Swenson RS. The nephrotic syndrome: A complication of massive obesity. Ann Intern Med. Vol. 81, No. 4, 1974, pp. 440-447.
 Warnke RA and Kempson R. The nephrotic syndrome in massive obesity. A study by light, immunofluorescence and electron microscopy. Arch Pathol Lab Med. Vol. 102, No. 8, 1978, pp. 431-438.
 Jennette JC, Charles L, and Grubb W. Glomerulomegaly and focal segmental glomerulosclerosis associated with obesity and sleep apnea syndrome. Am J Kidney Dis. Vol. 10, No. 6, 1987, pp. 470-472.
 Kambham N, Markowitz GS, Valeri AM, Lin J, and D’Agati VD. Obesity-related glomerulopathy: An emerging epidemic. Kidney Int. Vol. 59, No. 4, 2001, pp. 1498-1509.
 Huan Y, Tomaszewski JE, and Cohen DL. Resolution of nephritic syndrome after successful bariatric surgery in patients with biopsy-proven FSGS. Clin Nephrol. Vol. 71, No. 1, 2009, pp. 69-73.
 Kitamura K, Kangawa K, Kawamoto M, Ichiki Y, Nakamura S, Matsuo H, and Eto T. Adrenomedullin: A novel hypotensive peptide isolated from human pheochromocytoma. Biochem Biophys Res Commun. Vol. 192, No. 2, 1993, pp. 553-560.
 Li Y, Jiang C, Wang X, Zhang Y, Shibahara S, and Takahashi K. Adrenomedullin is a novel adipokine: adrenomedullin in adipocytes and adipose tissues. Peptides. Vol. 28, No. 5, 2007, pp. 1129-1143.
 Nomura I, Kato J, Tokashiki M, and Kitamura K. Increased plasma levels of the mature and intermediate forms of adrenomedullin in obesity. Regul Pept. Vol. 158, No. 1-3, 2009, pp. 127-131.
 Vila G, Riedl M, Maier C, Struck J, Morgenthaler NG, Handisurya A, Prager G, Ludvik B, Clodi M, and Luger A. Plasma MR-pro ADM correlates to BMI and decreases in relation to leptin after gastric bypass surgery. Obesity. Vol. 17, No. 6, 2009, pp. 1184-1188.
 Kubo A, Kurioka H, Minamino N, Sato H, Nishino T, Iwano M, Shiiki H, Matsuo H, and Dohi K. Plasma and urinary adrenomedullin in chronic glomerulonephritis patients with proteinuria. Nephron. Vol. 80, No. 2, 1998, pp. 227-230.
 Balat A, Cekmen M, Yürekli M, Gülcan H, Kutlu O, Türk?z Y, and Yologlu S. Adrenomedullin and nitrite levels in children with minimal change nephrotic syndrome. Pediatr Nephrol. Vol. 15, No. 1-2, 2000, pp. 70-73.