A Case of Double Tumor of Hepatocellular Carcinoma and Hormon-Producing Adrenal Gland Adenoma

Hidetaka Yamanaka, Eizi Nishigaki, Akiko Okazima, Tomonori Sugiura, Satoru Kawai, Yoshito Okada, Yoshimi Kitagawa, Hiroshi Kono and Yutaka Matsuura

Department of Surgery, Nagoya Ekisaikai Hospital

We report a rare case of coexisting hepatocellular carcinoma and aldosterone-producing adrenal gland adenoma. 64-year-old man admitted for acute myocardial infarction and angina pectoris was shown by laboratory data to have hypernatremia, hypokalemia, liver dysfunction, positive hepatitis C virus antibody and elevated PIVKA-II. Hormonal examination, standing shoulder and tolerance of angiotensin-converting enzyme inhibitor showed no responsive hyporeninemia or hyperaldosteronemia. Abdominal computed tomography showed an enhanced liver tumor in S8 and a left adrenal gland tumor. Abdominal angiography showed a tumor stain in S8 of the liver, and adrenal gland scintigraphy showed a hot tumor in the left adrenal gland. He was diagnosed with hepatocellular carcinoma with liver cirrhosis and aldosterone-producing adrenal gland adenoma. During medication for acute myocardial infarction and angina pectoris, we conducted transarterial embolization for hepatocellular carcinoma and drug control for Conn's syndrome. After heart function stabilized, he underwent hepatectomy of the anterior segment and left adrenalectomy. Resected specimens showed hepatocellular carcinoma and left adrenal gland adenoma. Liver cirrhosis was also recognized. It is important to think region of the adrenal gland caused by secondary aldosteronisms in hepatocellular carcinoma with liver cirrhosis.

Key words
Conn's syndrome, secondary aldosteronism, hepatocellular carcinoma

Reprint requests
Hidetaka Yamanaka Department of Surgery, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya, 454-8502 JAPAN

Accepted
January 30, 2002

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