RESUMEN
A 61-year-old Japanese woman was hospitalized because of general malaise. The patient demonstrated hypertension, hypokalemia and chronic renal failure (CRF). Plasma aldosterone concentration and urinary excretion of aldosterone were elevated. Abdominal computed tomographic scan revealed right adrenal tumor and multiple cysts in both kidneys. Adrenal scintigram using 131I-adosterol disclosed uptake of the isotope in the area corresponding to the adrenal tumor. Plasma aldosterone concentration and renin activity (PRA) in an upright posture and daily variations in adrenocorticotropic hormone, cortisol, aldosterone levels and PRA were compatible with aldosterone-producing adrenocortical adenoma. After administration of spironolactone and manidipine hydrochloride, a calcium antagonist, general malaise disappeared, and blood pressure and serum potassium level returned to the normal range without adrenalectomy. Although adrenalectomy is known to be effective for the treatment of aldosterone-producing adrenocortical adenoma, several papers reporting cases of aldosterone-producing adrenocortical adenoma with CRF indicated that surgical therapy was not always optimal in terms of postoperative conditions. Taken together, the conservative therapy may be one of the choices considering the prognoses of hypertension and renal dysfunction in patients with aldosterone-producing adrenocortical adenoma with CRF.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/complicaciones , Adenoma Corticosuprarrenal/complicaciones , Aldosterona/metabolismo , Fallo Renal Crónico/complicaciones , Neoplasias de la Corteza Suprarrenal/diagnóstico , Neoplasias de la Corteza Suprarrenal/metabolismo , Neoplasias de la Corteza Suprarrenal/terapia , Adenoma Corticosuprarrenal/diagnóstico , Adenoma Corticosuprarrenal/metabolismo , Adenoma Corticosuprarrenal/terapia , Hormona Adrenocorticotrópica/sangre , Aldosterona/sangre , Femenino , Humanos , Hidrocortisona/sangre , Persona de Mediana Edad , Renina/sangreRESUMEN
To assess the rate-limiting factor of oxygen uptake (VO2) kinetics at the onset of exercise, six healthy male sedentary subjects performed repeated one-legged constant-load cycle exercise. The one-legged constant-load exercise test consisted of two 5-min periods of pedalling at an exercise intensity of 50 W, with a 5-min rest between periods (these exercise periods, i.e. first and second exercises, were performed by the same leg). The exercise was then repeated using the other leg. In addition, two-legged incremental exercise was investigated to establish whether VO2 kinetics were affected by slower heart rate kinetics. The incremental exercise test consisted of two-legged pedalling first with the cycle unloaded as a warm-up for 5 min followed by 50-W exercise for 5 min. The exercise intensity was then increased to 100 W for 5 min. During exercise, gas exchange parameters were determined by the breath-by-breath method and cardiac output (Qc) was determined continuously by an impedance technique with a computer-based automated system. To determine the kinetics of heart rate (HR), Qc, and VO2, a best fit procedure was employed using least-squares criteria with a time delay, except during the initial increase. During the one-legged constant-load exercise test, VO2 kinetics were significantly accelerated by repeated exercise using the same leg. On the other hand, when the exercise was changed to the other leg, VO2 kinetics were significantly slower, although Qc kinetics continued to be faster. During the incremental exercise test, although the HR response was slower at the transition from 50-W to 100-W exercise than at the transition from warm-up to 50-W exercise, there were no significant changes in VO2 kinetics.(ABSTRACT TRUNCATED AT 250 WORDS)