研究者詳細 - 木内　謙一郎

論文 - 木内　謙一郎

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PS-R07-3: BILATERAL ADRENAL TUMORS IN A PATIENT WITH PRIMARY ALDOSTERONISM CONCURRENT WITH CUSHING'S SYNDROME: A CASE REPORT.

Yusuke Otomo, Junichiro Irie, Kazutoshi Miyashita, Sakiko Kobayashi, Kenichiro Kinouchi, Toshifumi Nakamura, Yusuke Kubota, Takeshi Nishimura, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e510 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Both primary aldosteronism (PA) and Cushing's syndrome (CS) cause hypertension. It is known that PA can be complicated with CS, but cases with both bilateral PA and unilateral CS are rare.</jats:p> </jats:sec> <jats:sec> <jats:title>Case presentation:</jats:title> <jats:p>A 65-year-old male patient was treated on 10 mg of amlodipine and 2 mg of doxazosin for hypertension from 6 years ago and his blood pressure was about 150/90 mm Hg on average. Because he gained 10 kg of weight over the last 6 months, he visited his primary physician. He had moon face and central obesity, and his blood examination showed the high concentrations of adrenal hormones, i.e., plasma aldosterone concentration (PAC) was 180 pg/mL and plasma renin activity (PRA) was 0.9 ng/mL/h (aldosterone-renin ratio (ARR) was 200.2), cortisol was 11.1 mcg/dL and adrenocorticotropic hormone was undetectable. The twenty-four-hour urine test showed that the greater secretion of adrenal hormones, i.e., aldosterone was 21.4 mcg/day, free cortisol was 148.5 mcg/day (sodium was 190 mEq/day). The computed tomography scan showed bilateral adrenal tumors (37 mm on the left and 8 mm on the right, respectively). The captopril challenge test, the furosemide stress test, and the 1 mg and 8 mg dexamethasone suppression tests were conducted, and he was diagnosed with both PA and CS. By adrenal scintigraphy using 131I-adosterol, high accumulation was detected in the left adrenal gland, whereas there was no accumulation in the right adrenal gland. Hence, the tumor of the left adrenal gland was likely a cortisol-secreting adrenocortical tumor. Furthermore, super-selective adrenal venous sampling indicated autonomous aldosterone secretion from bilateral adrenal glands. The patient underwent laparoscopic left adrenalectomy and the hypercortisolism was corrected. He lost 10 kg of weight 1 year after the surgery. PA remained as indicated by the blood test showing that PRA was 1.2 ng/mL/h, PAC was 347 pg/mL (ARR was 289.2). He is treated with 5 mg of esaxerenone, and his blood pressure is 130/70 mmHg on average.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Adrenal venous sampling was able to determine laterality of PA with coexisting CS.</jats:p> </jats:sec>

PS-R04-3: A CASE OF RESISTANT HYPERTENSION

Yuya Nakajima, Junichiro Irie, Toshifumi Nakamura, Yoshinaga Kawano, Arata Ito, Kenichiro Kinouchi, Sakiko Kobayashi, Shu Meguro, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e440 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg despite the use of three antihypertensive medications of different classes at the maximally tolerated doses, one of which is a diuretic. It is reported that approximately 10% of patients with hypertension have resistant hypertension, but the optimal management of resistant hypertension remains to be unclear.</jats:p> </jats:sec> <jats:sec> <jats:title>Case presentation:</jats:title> <jats:p>A 56-year-old Japanese woman visited our hospital because she presented high blood pressure of about 170/100 mm Hg even after the treatment by her primary physician. She had hypertension after giving birth at age 26 and her blood pressure was about 170/100 mm Hg. She was suspected of having secondary hypertension and the laboratory and imaging examination were conducted. The functions of the adrenal gland and thyroid were normal, and the renal artery stenosis and chronic kidney disease were excluded. She did not have NSAIDs, oral contraceptives, and herbal products. Although she had been intensively treated for hypertension, she suffered from a brain hemorrhage. Her systolic blood pressure has been still not controlled appropriately by 80 mg of nifedipine, 400 mg of the combination of sacubitril/valsartan, 2.5 mg of esaxerenone, 2 mg of trichlormethiazide, and 9 mg of bisoprolol transdermal patch daily.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Because patients with resistant hypertension have a higher risk of stroke, kidney disease, and heart failure, the careful examination and intensive treatment are necessary.</jats:p> </jats:sec>

PS-R03-7: PARTIAL ADRENALECTOMY IN A PATIENT WITH ACTH-INDEPENDENT MACRONODULAR ADRENAL HYPERPLASIA: A CASE REPORT

Shunta Takebayashi, Junichiro Irie, Isao Kurihara, Sakiko Kobayashi, Kazutoshi Miyashita, Kenichiro Kinouchi, Toshifumi Nakamura, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e438 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Background:</jats:title> <jats:p>The standard treatment for ACTH-independent macronodular adrenal hyperplasia (AIMAH) with overt Cushing's syndrome is bilateral adrenalectomy. Here we show a case of AIMAH who underwent total adrenalectomy on one side and partial adrenalectomy on the other, resulting in the successful debulking of cortisol-secreting adrenal masses and improvement of Cushing's syndrome, yet not necessitating postoperative steroid replacement.</jats:p> </jats:sec> <jats:sec> <jats:title>Case presentation:</jats:title> <jats:p>A 74-year-old female patient with hypertension, type 2 diabetes and dyslipidemia developed edema of the legs. She visited her primary physician and was found to have lumbar vertebral compression fractures. The blood test and 24-hr urine collection revealed the plasma cortisol levels of 26.1 μg per dL, adrenocorticotropic hormone of 1.1 pg per mL, and urine free cortisol of 340 μg per day. Computed tomographic scan and adrenal scintigraphy confirmed bilateral adrenal nodules with notable tracer uptake. Diagnosis of AIMAH with Cushing's syndrome was made. Laparoscopic partial adrenalectomy, i.e., total removal of the left adrenal gland and partial removal of the right counterpart, was conducted aiming to avert from steroid replacement therapy. After the surgery, blood pressure and glycemic control were markedly improved and maintained for 4 years whilst adrenocortical functions were preserved.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Partial adrenalectomy could be an effective therapy in selected cases of AIMAH.</jats:p> </jats:sec>

PS-R03-4: TRANSARTERIAL EMBOLIZATION, THORACIC SPINE DECOMPRESSION AND FUSION OF METASTATIC PHEOCHROMOCYTOMA: A CASE REPORT

Kenichiro Kinouchi, Yosuke Mizutani, Toshifumi Nakamura, Shintaro Yamaguchi, Koichiro Homma, Sakiko Kobayashi, Kazutoshi Miyashita, Isao Kurihara, Hirotaka Shibata, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e437 - e438 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:p>Surveillance of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma remain a fundamental problem to be solved. Here we present a 60-year-old male who visited a local clinic because of headache, sweating, malaise, and loss of body weight. Hypertension, orthostatic hypotension, along with remarkable increase in serum and urine noradrenaline, and urine metanephrine and vanillylmandelic acid were noted, and pheochromocytoma was suspected accordingly. Magnetic resonance imaging failed to reveal adrenal gland or sympathetic plexuses, yet it uncovered metastatic lesions in the liver and spine. Functional imaging study using 131I-Metaiodobenzylguanidine (MIBG) scan detected notable uptake in the spinal lesion, albeit not in the hepatic lesion. On the other hand, positron emission tomography with fluorodeoxyglucose (FDG-PET) disclosed FDG uptake both in the hepatic and spinal masses. Biopsy of the hepatic tumors revealed chromogranin A-positive clusters of cells, a finding consistent with metastatic pheochromocytoma. Transarterial embolization (TAE) of the metastatic tumors in the liver was performed for the purpose of tumor mass reduction. Additionally, TAE followed by resection of the spinal lesion was conducted. Pathological examination of the spinal tumor also showed chromogranin A-positive cells, leading to diagnosis of malignant pheochromocytoma. Crucially, TAE of the liver and spinal tumors resulted in dramatic reduction of catecholamine production, likely constituting an effective therapeutic strategy against metastatic pheochromocytoma (Homma, et al. Hypertens Res 2006). Afterwards, the patient became unable to walk because of weakness in the left leg at the age of 64. It seemed attributed to spinal cord compression from the tumor at the level of thoracic vertebrae 7. The patient underwent posterior decompression and fusion, and his muscle strength of the left leg was recovered. At the age of 65, the patient developed paralytic ileus following a surgery against metastatic tumors in the skull. In this case report, we discuss early detection of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma.</jats:p>

PS-R03-3: INTERMITTENTLY SCANNED CONTINUOUS GLUCOSE MONITORING IN A DIFFICULT PATIENT WITH GESTATIONAL DIABETES MELLITUS AND SUBCLINICAL CUSHING'S SYNDROME: A CASE REPORT

Akihide Iwahara, Kazutoshi Sugiyama, Tami Tsuchiya, Arata Itoh, Yuya Nakajima, Yoshifumi Saisho, Kenichiro Kinouchi, Sakiko Kobayashi, Kazutoshi Miyashita, Junichiro Irie, Shu Meguro, Satoru Ikenoue, Mamoru Tanaka, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e437 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:p>A 41-year-old woman was admitted to the obstetrics department because of epigastric pain, nausea, and fatigue at 31 weeks of gestation. She was suspected of subclinical Cushing's syndrome based on high plasma cortisol and low ACTH levels along with an incidentally discovered tumor in the left adrenal gland 4 years prior to conception. 3 months before admission, 75 g oral glucose tolerance test yielded one point positive (81–169–174 mg/dL) and diagnosis of gestational diabetes mellitus was made. Diet and exercise therapy was started on an outpatient basis. While blood glucose control had been favorable, she discontinued visits to outpatient clinics due to difficulty in physical activity.</jats:p> <jats:p>At the time of admission, blood glucose level was running more than 200 mg/dl, and self-monitoring of blood glucose (SMBG) and insulin self-injection therapy were proposed for immediate blood glucose control accordingly. However, the patient had psychiatric symptoms that were presumably associated with delusional disorder and subclinical Cushing's syndrome. As such, she refused to implement both procedures on account of a strong fear against puncture, which caused blood glucose management difficult. Despite understanding the necessity of SMBG and potential risks to the fetus, the patient frequently expressed anxiety and could not perform SMBG. Given the difficult circumstance, intermittently scanned continuous glucose monitoring was installed to reduce invasive procedures. As a result, blood glucose levels were under good control with 0.43 U/kg of insulin per day until the delivery by cesarean section at 34 weeks of gestation. A healthy infant weighing 2442 g was delivered without complications.</jats:p> <jats:p>Here we highlight utility and efficacy of intermittently scanned continuous glucose monitoring in a difficult patient with gestational diabetes mellitus and subclinical Cushing's syndrome.</jats:p>

PS-C22-6: PERFORMANCE OF PREDICTION ALGORITHM FOR THE SUBTYPE DIAGNOSIS OF PRIMARY ALDOSTERONISM WHICH WAS ADVOCATED IN THE JAPAN PRIMARY ALDOSTERONISM STUDY

Sakiko Kobayashi, Isao Kurihara, Kenichi Yokota, Kenichiro Kinouchi, Toshifumi Nakamura, Kazutoshi Miyashita, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e402 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>In the part of the Japan Primary Aldosteronism Study (JPAS), the prediction algorithm for the subtype diagnosis of primary aldosteronism (PA) was advocated and published in 2018 (Umakoshi.H et.al, J Clin Endocrinol Metab, 2018, 103(3):900–908). In the algorithm, patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateral form of PA in AVS (6.2%) and could be treated medically, whereas those with unilateral visible mass on CT and presence of hypokalemia have a high probability of a lateralized form of PA in AVS (70.6%). To validate the efficacy of the algorithm, we applied the algorithm for recent PA cases in our institute, Keio University hospital.</jats:p> </jats:sec> <jats:sec> <jats:title>Patients:</jats:title> <jats:p>A total of 77 patients with PA who underwent adrenal venous sampling (AVS) between November 2018 and October 2019 were enrolled in this study. They were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>In our case, the prevalence for unilateral hyperaldosteronism on AVS was as follows: CT-negative with normokalemia, 7.9%; CT-positive with normokalemia, 15.4%; CT-negative with hypokalemia 22.2%, and CT-positive, 71.4%. The results were quite similar to the results in the previous report. In the algorithm, it was stated that AVS could be spared in patients with unilateral lesion on CT and hypokalemia if they were younger than 35 years, however, in our cases, there was one patient whose age was 30 with unilateral lesion on CT and hypokalemia and the AVS result of whom indicated bilateral PA. In the algorithm, it was also stated that AVS could be spared in patients with bilateral lesions on CT and normokalemia if plasma aldosterone concentration was less than 8 ng/dl and it was consistent in our cases.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Overall, the prediction algorithm for the subtype diagnosis of PA developed in JPAS could be applied well in our recent PA cases.</jats:p> </jats:sec>

PS-BPR02-4: RENOVASCULAR HYPERTENSION FROM FIBROMUSCULAR DYSPLASIA WITHOUT ABNORMALITIES IN RENAL DOPPLER ULTRASOUND: A CASE REPORT.

Kyosuke Kato, Yosuke Mizutani, Toshifumi Nakamura, Kenichiro Kinouchi, Sakiko Kobayashi, Kazutoshi Miyashita, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e350 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Renovascular hypertension (RVH) is one of the most common forms of secondary hypertension, and accounts for nearly 1% of all hypertension cases. It is characterized by compromised renal perfusion pressure, resultant renin secretion, and hypokalemia due to secondary hyperaldosteronism. Arteriosclerosis is a common underlying pathogenesis in middle-aged and older adults, whilst fibromuscular dysplasia is occasionally seen in younger patients with RVH. Since cardiovascular complications are of grave concern in RVH, early detection and appropriate therapeutic intervention are particularly important. Here, we report a case of renovascular hypertension from fibromuscular dysplasia which was incidentally unveiled during close examination of an adrenal tumor.</jats:p> </jats:sec> <jats:sec> <jats:title>Case report:</jats:title> <jats:p>A 55-year-old woman was being treated for hypertension by her primary care physician. She was referred to our hospital for a thorough examination of her right ureteral stone, which necessitated a CT scan incidentally revealing an left adrenal nodule measuring 8 mm in size. Primary aldosteronism was unlikely based on the lack of renin suppression (active renin concentration, 36.5 pg/mL; plasma aldosterone levels, 263 pg/mL and aldosterone-renin ratio < 40 under treatment with nifedipine 40 mg/day. Ultrasound of the kidney demonstrated a notable difference in size between the right and left kidneys of 87 mm and 106 mm, respectively, albeit Renal Artery Doppler failed to suggest the renal artery stenosis. CT scan with contrast material revealed the remarkable irregularity and “string on beads” sign on the distal main trunk of the right renal artery. Renovascular hypertension from fibromyalgia dysplasia was suspected, and percutaneous renal artery angioplasty was performed. After the pressure gradient across the stenotic lesion (105/99 mmHg on the distal side and 125/67 mmHg on the proximal side of the renal artery) was verified, balloon dilation was applied. The procedure was successful as the pressure gradient virtually resolved (105/95 mmHg on the distal side and 109/101 mmHg on the proximal side of the renal artery). Digital subtraction angiography indeed reaffirmed improvement in blood flow.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Renovascular hypertension can go unnoticed solely based on renal Doppler Ultrasound. This was a case in which renovascular hypertension from fibromuscular dysplasia was incidentally identified in CT scan designated as a work-up for an adrenal tumor.</jats:p> </jats:sec>

PS-BPR01-4: A CASE OF ALDOSTERONE-PRODUCING ADENOMA DIAGNOSED BY ADRENAL ARTERIOGRAPHY AND BRANCH SELECTIVE ADRENAL VENOUS SAMPLING

Masaru Nishikawa, Kenichiro Kinouchi, Sakiko Kobayashi, Kazutoshi Miyashita, Toshikazu Takeda, Masashi Tamura, Seishi Nakatsuka, Yosuke Mizutani, Yusuke Otomo, Kazuki Aoyama, Kenichi Yokota, Isao Kurihara, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e345 - e346 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Case report:</jats:title> <jats:p>A 43-year-old man had been followed up for hypertension and hypokalemia, but self-interrupted his hospital visits for the last four years. Based on the serum potassium level of 2.7 mEq/L, plasma aldosterone concentration of 202 pg/mL, and plasma renin activity of 1.1 ng/mL/hr, he was suspected of primary aldosteronism and was admitted to the previous hospital. A saline suppression test and a rapid ACTH stimulation test were both positive, and 24-hr urinary aldosterone level was 19 μg/day under sodium loading of 170 mEq/day, leading to the diagnosis of primary aldosteronism. Since contrast-enhanced CT showed an 8 mm-sized adenoma in the lower portion of the left adrenal gland, an aldosterone-producing adenoma was suspected and a non-segmental adrenal venous sampling (AVS) was performed. However, it yielded apparent bilateral aldosterone suppression in the main trunk of the bilateral adrenal veins, where the aldosterone-to-cortisol (A/C) ratio was lower than that in the inferior vena cava even after ACTH loading. The patient was referred to our hospital for a segmental AVS. Arteriography was first performed from the left inferior adrenal artery to confirm the outflow vessels from the adenoma. Strikingly, there was an aberrant vein which drained into the proximal segment of the left adrenal vein. CT imaging at the time of arteriography revealed, in addition to the known adenoma, a 6 mm-sized micronodule in the lateral region of the left adrenal gland, and the aberrant vein appeared to be the main outflow vessel from the micronodule. A segmental AVS was performed, and blood samples were taken from the bilateral adrenal veins including the aberrant vein and the main trunk of the left adrenal vein proximal to its confluence. The A/C ratio was highest in the aberrant vein, followed by in the main trunk of the proximal left adrenal vein, while it was markedly suppressed in other branches and the main trunk of the left adrenal vein distal to the confluence of the aberrant vein. Based on these results, the presence of aldosterone-producing adenoma in the left adrenal gland was suggested. Laparoscopic partial left adrenalectomy was performed without postoperative complications. Hypertension and hypokalemia were fully resolved afterwards.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Adrenal arteriography and segmental AVS should be considered in such cases that apparent bilateral aldosterone suppression is noted in conventional AVS in patients with clinically suspected aldosterone-producing adenoma.</jats:p> </jats:sec>

PS-BPR01-3: DISSOCIATION OF SERUM ALDOSTERONE CONCENTRATIONS BETWEEN THE MEASUREMENT METHODS: A CASE REPORT

Takuto Torimitsu, Kenichiro Kinouchi, Kyosuke Kato, Akihide Iwahara, Takahide Kozuma, Toshifumi Nakamura, Sakiko Kobayashi, Kazuki Miyashita, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e345 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:p>A 89-year-old woman was admitted to our hospital for syncope in 20XX-13. During the hospitalization, hypertension was pointed out. Despite 4 cm left adrenal mass suggestive of myelolipoma in contrast-enhanced magnetic resonance imaging (MRI), the serum and urine hormone levels in relation to secondary hypertension was within normal limits. Diagnosis of essential hypertension was made and treatment with olmesartan and azelnidipine was begun. In 20XX-5, her blood pressure was well controlled, and serum aldosterone level and active renin concentration (ARC) were 167 pg/ml and 6.8 pg/ml, respectively. Annual computed tomography (CT) scans showed virtually the same size of the adrenal tumor over 5 years. The trend toward increase in her blood pressure prompted us to repeat a blood test in 20XX, which turned out that serum aldosterone concentration was extremely high (1144 pg/ml), while ARC was suppressed to 1.7 pg/ml. In light of positive captopril challenge test, primary aldosteronism was suspected, and she was admitted to our hospital. However, systolic blood pressure was only mildly elevated (130 mmHg), though blood pressure medication had not been changed for 5 years. In addition, serum potassium value was 4.7 mEq/L and 24-hr urinary aldosterone was merely 3.4 μg/day under the salt-loaded state, which was inconsistent with exceedingly high serum aldosterone concentration and argued against the diagnosis of primary aldosteronism. Hence, validity of the method to quantitate serum aldosterone levels was questioned. To determine serum aldosterone concentration, radioimmunoassay (RIA) was applied in 20XX-5, yet chemiluminescent enzyme immunoassay (CLEIA) has been introduced since 20XX. Strikingly, reexamination of the same serum sample discovered that serum aldosterone value of 770 pg/ml in CLEIA was equivalent to 59 pg/ml by RIA method. As such, marked dissociation seems present between the two types of assays in this particular patient. Although tendency of correlation with regard to serum aldosterone levels between the two methods have been clarified, attention needs to be paid for the exception as in this case. Thus, it is fundamental to thoroughly evaluate patients with suspected primary aldosteronism as to whether the clinical course and serum aldosterone levels are compatible, and if not, it may be necessary to change the measurement method.</jats:p>

PS-BPC08-6: CLINICAL AND BIOCHEMICAL OUTCOMES OF PATIENTS WITH ALDOSTERONE-PRODUCING ADENOMA AFTER RADIOFREQUENCY ABLATION THERAPY AT KEIO UNIVERSITY HOSPITAL: 2022 REPORT

Takahide Kozuma, Sakiko Kobayashi, Toshifumi Nakamura, Kenichiro Kinouchi, Kenichi Yokota, Kazutoshi Miyashita, Isao Kurihara, Kei Takase, Seishi Nakatsuka, Hiroshi Itoh

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e314 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title>Objectives:</jats:title> <jats:p>Total adrenalectomy of an affected adrenal gland is the standard therapy of aldosterone-producing adenoma (APA), a curable subtype of primary aldosteronism. However, the APA is occasionally inoperable in cases with bilateral adenomas or high-risk patients under general anesthesia. Computed tomography (CT)-guided radiofrequency ablation (RFA) of the adrenal gland is a less invasive, cortical-sparing therapy, and may become a treatment of choice for such cases. A multicenter clinical trial of RFA was conducted in patients with APA in Japan from 2015 to 2016. To establish its long-term efficacy and safety, the study subjects enrolled in Keio University Hospital have been annually followed up. Following the progress report at ISH 2018, here we update clinical and biochemical outcomes of this cohort of patients 6 years after the RFA treatment.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Follow-up medical interviews, blood pressure measurements, blood tests, and urinalysis were done annually. In addition, at least one CT scan was performed since 2018. Data on antihypertensive medication, blood pressure, hormone and electrolyte levels, urinary albumin, and tumor size were collected and analyzed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>10 cases of APA were treated with RFA between June 2015 and March 2016. As of April 2022, 6 cases were successfully followed up. Of these patients, the aldosterone-to-renin ratio (ARR) remained normalized in 5 cases (83%), albeit above the upper limit in 1 case (17%). In this particular patient, serum potassium level remained normalized and antihypertensive medication was not needed. Antihypertensive medication was needed in 1 case (17%), while urinary albumin levels were improved in all cases. Of note, follow-up CT scan showed that the tumor was undetectable in 1 case (17%), reduced in size in 3 cases (50%) and unchanged in 2 cases (33%). None of the cases have developed adrenal insufficiency since the RFA.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>The follow-up study on APA patients 6-year after the RFA revealed no cases of recurrence. RFA is likely to be effective and safe in patients with APA.</jats:p> </jats:sec>

PS-BPB01-2: VASCULAR ENDOTHELIAL NAMPT-MEDIATED NAD+ BIOSYNTHESIS REGULATES WHOLE-BODY BLOOD PRESSURE AND INSULIN RESISTANCE

Shotaro Kosugi, Shintaro Yamaguchi, Koichiro Homma, Taichi Nagahisa, Ken Nishioka, Yasuhiro Watanabe, Kenichiro Kinouchi, Kaori Hayashi, Kazutoshi Miyasita, Takeshi Kanda, Junichiro Irie, Jun Yoshino, Hiroshi Ito

Journal of Hypertension （Ovid Technologies (Wolters Kluwer Health)） 41 e264 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 02636352

<jats:sec> <jats:title/> <jats:p>Obesity is associated with dysregulation in blood pressure control and whole-body glucose metabolism, but the precise underlying mechanism(s) remain unclear. Here, we generated and characterized mice with vascular endothelial-cell specific deletion of nicotinamide phosphoribosyltransferase (NAMPT), which mediates the biosynthesis of nicotinamide adenine dinucleotide (NAD<jats:sup>+</jats:sup>), a key regulator of cellular energy metabolism. We found that vascular endothelial cell-specific <jats:italic toggle="yes">Nampt</jats:italic> knockout (VeNKO) mice exhibited 1) higher blood pressure (systolic blood pressure; flox/flox mice: 111 ± 2.6 mmHg, VeNKO mice: 134 ± 4.0 mmHg, p < 0.05) with cardiac hypertrophy (flox/flox mice: 5.0 mg/g-body weight, VeNKO mice: 6.1 mg/g-body weight, p < 0.05) and 2) insulin resistance with abnormal fat distribution, under high-fat diet feeding. These deleterious alterations were partially rescued by administering nicotinamide mononucleotide (NMN), a key NAD<jats:sup>+</jats:sup> intermediate. Taken together, our findings demonstrate that vascular endothelial NAMPT-mediated NAD<jats:sup>+</jats:sup> biosynthesis is involved in the regulation of blood pressure and whole-body glucose metabolism. Our study provides mechanistic and therapeutic insights into vascular endothelia NAD<jats:sup>+</jats:sup> biology related to obesity-associated hypertension and insulin resistance.</jats:p> </jats:sec>

Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus: A randomized, crossover trial

Takashi Murata, Kiminori Hosoda, Kunihiro Nishimura, Yoshihiro Miyamoto, Naoki Sakane, Noriko Satoh-Asahara, Masao Toyoda, Yushi Hirota, Munehide Matsuhisa, Akio Kuroda, Ken Kato, Ryuji Kouyama, Junnosuke Miura, Atsuhito Tone, Masato Kasahara, Shu Kasama, Shota Suzuki, Yukie Ito, Tomokazu Watanabe, Akiko Suganuma, Zhuo Shen, Hiroko Kobayashi, Satoshi Takagi, Sari Hoshina, Kanako Shimura, Yukiko Tsuchida, Moritsugu Kimura, Nobumichi Saito, Akira Shimada, Yoichi Oikawa, Atsushi Satomura, Akifumi Haisa, Satoshi Kawashima, Shu Meguro, Hiroshi Itoh, Yoshifumi Saisho, Junichiro Irie, Masami Tanaka, Masanori Mitsuishi, Yuya Nakajima, Jun Inaishi, Kenichiro Kinouchi, Shintaro Yamaguchi, Arata Itoh, Kazutoshi Sugiyama, Kazuma Yagi, Tami Tsuchiya, Noriko Kodani, Ikki Shimizu, Tetsuya Fukuda, Yoshiki Kusunoki, Tomoyuki Katsuno, Yuka Matoba, Yumi Hitaka, Kentaro Abe, Natsuko Tanaka, Ryoko Taniguchi, Toshihiko Nagao, Kazuyuki Hida, Izumi Iseda, Masaya Takeda, Yuichi Matsushita, Masafumi Tenta, Tsuyoshi Tanaka, Kunichi Kouyama, Michiru Fukunaga

Diabetes Research and Clinical Practice （Elsevier BV） 195 110147 2023年01月

筆頭著者, 最終著者, 責任著者, ISSN 01688227

We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range.This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR;70 mg/dL).The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index 5 was significantly reduced (8.6 % vs 23.7 %, P 0.001).The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM.

術後良好な血圧コントロールが得られた先端巨大症の一例

児島大輝, 小林佐紀子, 木内謙一郎, 中村俊文, 水谷洋佑, 大喜多肇, 植田良, 宮下和季, 伊藤裕

日本腎臓学会誌（(一社)日本腎臓学会） 64 （ 6-E ） 610 - 610 2022年10月

筆頭著者, 最終著者, 責任著者, ISSN 0385-2385

2型糖尿病加療中に発見され原発不明癌の副腎転移が疑われた1例

渡辺麻里, 小林佐紀子, 宮下和季, 木内謙一郎, 中村俊文, 水谷洋佑, 平田賢郎, 伊藤史麿, 上野彰久, 真杉洋平, 中塚誠之, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 2 ） 601 - 601 2022年10月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

10年の経過で緩徐に増大し診断された散発性甲状腺髄様癌の一例

河本ひかり, 小林佐紀子, 中村俊文, 木内謙一郎, 宮下和季, 水谷洋佑, 川井田みほ, 竹林亜貴子, 小澤宏之, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 2 ） 579 - 579 2022年10月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

isCGMを活用し周術期血糖管理を行なった認知症合併1型糖尿病の1例

木内謙一郎, 中島裕也, 三石正憲, 税所芳文, 入江潤一郎, 田中正巳, 目黒周, 伊藤裕

糖尿病（(一社)日本糖尿病学会） 65 （ 7 ） 394 - 394 2022年07月

筆頭著者, 最終著者, 責任著者, ISSN 0021-437X

血糖測定の協力が得られず血糖管理に難渋したサブクリニカルクッシング症候群合併妊娠糖尿病の一例

岩原彰秀, 渡辺麻里, 西川賢, 河本ひかり, 杉山和俊, 土屋多美, 伊藤新, 中島裕也, 税所芳史, 木内謙一郎, 宮下和季, 小林佐紀子, 入江潤一郎, 目黒周, 池ノ上学, 田中守, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 1 ） 368 - 368 2022年04月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

褐色細胞腫術後に多発性肺転移が認められ手術を施行した症例

水谷洋佑, 宮下和季, 小林佐紀子, 木内謙一郎, 加藤恭介, 渡辺康博, 矢野海斗, 大久保裕, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 1 ） 388 - 388 2022年04月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

Epoprostenolによる薬剤性甲状腺中毒症の1例

加藤恭介, 古田島太希, 宮下和季, 小林佐紀子, 木内謙一郎, 水谷洋佑, 高橋利奈, 大友佑介, 西川賢, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 1 ） 354 - 354 2022年04月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

再発時に異所性ACTH症候群を指摘された嗅神経芽細胞腫に薬物療法を試みた一例

洲之内真理愛, 宮下和季, 小林佐紀子, 木内謙一郎, 水谷洋佑, 渡辺康博, 加藤恭介, 岩原彰秀, 御子柴卓弥, 小澤宏之, 伊藤裕

日本内分泌学会雑誌（(一社)日本内分泌学会） 98 （ 1 ） 405 - 405 2022年04月

筆頭著者, 最終著者, 責任著者, ISSN 0029-0661

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