J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 1882KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 88(10): 1423-1429, 1987

Original article

DIAGNOSIS OF ADRENAL MEDULLARY DISEASES IN PATIENTS WITH SPORADIC OR HEREDITARY MEDULLARY THYROID CARCINOMA.
A REPORT OF 37 CASES WITH A MAXIMUM 8-YEAR FOLLOW-UP STUDY

Second Department of Surgery, Kagawa Medical School, Kagawa, Japan
*) Kuma Hospital, Kobe, Japan
**) Department of Radiology and Nuclear Medicine, Kyoto University Faculty of Medicin, Kyoto, Japan
***) Department of Medicine and Geriatrics, Osaka University Medical School, Osaka, Japan

Akira Miyauchi, Fumio Matsuzaka*), Kanji Kuma*), Keigo Endo**), Toshio Ogihara***), Masazumi Maeda

Thirty-seven patients with medullary thyroid carcinoma were investigated to determine the status of adrenal medulla by computed tomography and 131I-metaiodobenzylguanidine (131I-MIBG) scintigraphy as well as measurements of urinary catecholamine excretion. Patients were followed up for 8 years in maximum.
Fifteen patients belonged to multiple endocrine neoplasia type 2 including patients with incomplete phenotype. Computed tomography demonstrated adrenal tumors or enlargement in all 6 patients with urinary epinephrine (E) more than 30μg/day, 4 of them were confirmed to have pheochromocytoma or adrenal medullary hyperplasia by surgery. In 2 patients with E less than 30μg/day and epinephrine to norepinephrine (E/N) ratio more than 0.3 suggesting adrenal medullary hyperfunction, computed tomography revealed small adrenal tumors. Three of the remaining 7 patients with E less than 30μg/day and E/N ratio less than 0.3 had equivocal enlargement of unilateral gland on computed tomography.
131I-MIBG scintigraphy demonstrated tracer uptake in adrenal glands with tumor more than 1cm in diameter. One of 2 adrenal glands with medullary hyperplasia showed a faint adrenal image on the scintiscan, but the other showed no tracer uptake.
Pheochromocytoma became manifest in 4 patients during the follow-up period, 4, 13, 14 and 34 years after thyroid surgery.
None of 22 patients with sporadic medullary thyroid carcinoma showed adrenal abnormalities on the examinations mentioned above.

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