Biomedical subjects

M Inada

Publications and source records attributed to M Inada.

At least 253 records · Page 14Linked to original sources

PubMed1990

Factors associated with pericardial effusion in acute Q wave myocardial infarction.

To elucidate the clinical characteristics associated with pericardial effusion in the early phase of myocardial infarction, 330 patients with acute Q wave infarction were studied. According to echocardiography, 83 patients had pericardial effusion on the third day of hospitalization, and careful auscultation revealed that a pericardial rub was absent in 45 patients and was present in 38 patients. Based on seven clinical variables, multivariate analysis was performed to determine the important variables related to the occurrence of pericardial effusion with and without pericardial rub. Pulmonary capillary wedge pressure and left ventricular segments with advanced asynergy were the significant factors related to the occurrence of pericardial effusion without a pericardial rub. The presence of ventricular aneurysmal motion, left ventricular segments with advanced asynergy, and alveolar arterial oxygen difference were related to pericardial effusion with a pericardial rub. Therefore, a hemodynamic factor was the major mechanism associated with the increase in extravascular myocardial fluid and the consequent occurrence of hydropericardia in the absence of a pericardial rub, whereas an increase in the microvascular permeability in the myocardium with excessive fluid exudating through the irritated epicardial surface was the mechanism related to pericardial effusion with a pericardial rub in the early phase of acute myocardial infarction.

Capillary Permeability↗

PubMed1990

Changes of atrial natriuretic peptide and its messenger RNA with development and regression of cardiac hypertrophy in renovascular hypertensive rats.

We assessed the changes in atrial natriuretic peptide (ANP) and its messenger RNA (mRNA) levels in atria and ventricles in relation to hemodynamic factors during antihypertensive treatments in two-kidney, one-clip renovascular hypertensive rats (RHRs). Hypertension of 10-week duration caused a twofold increase in the left ventricular weight/body weight ratio, a significant increase in left ventricular end-diastolic pressure, and an eightfold increase in left ventricular ANP mRNA levels in RHRs, as compared with the levels in control rats. Uninephrectomy or 4 weeks of treatment with the converting enzyme inhibitor enalapril reduced the blood pressure to the control level, with the complete reversal of left ventricular hypertrophy, left ventricular end-diastolic pressure, and ANP mRNA levels. Four weeks of treatment with the arterial vasodilator hydralazine significantly, but not completely, reduced the high blood pressure, but it did not influence left ventricular hypertrophy, end-diastolic pressure, and ANP mRNA levels. The increased ANP synthesis observed in the right ventricles of RHRs also reverted to the control level by uninephrectomy or enalapril treatment, but not by hydralazine, with a time course similar to that of left ventricular ANP. In addition, uninephrectomy caused the left and right ventricular ANP and ANP mRNA levels of RHRs to fall to the levels of control rats as early as 1 week, despite persistent left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Diabetes-induced alterations in atrial natriuretic peptide gene expression in Wistar-Kyoto and spontaneously hypertensive rats.

We investigated the effects of streptozotocin-induced diabetes on atrial natriuretic peptide (ANP) synthesis, hemodynamic parameters, blood volume, and histopathology, as well as the reversibility of such effects with insulin therapy in Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs). The biatrial ANP messenger RNA (mRNA) levels in the diabetic WKY rats increased by 16-17% compared with those in the age-matched WKY rats at 12 weeks after the onset of diabetes, whereas their ventricular ANP mRNA levels showed increases of 190% in left ventricles and 160% in right ventricles at 8 weeks. In the diabetic SHRs, the left atrial ANP mRNA levels increased by 36% compared with those in the age-matched SHRs, as early as 4 weeks after diabetes onset. Their ventricular ANP mRNA levels also showed 80-82% increases in left and right ventricles at 4 weeks. In proportion to changes in cardiac ANP synthesis, the biventricular end-diastolic pressures were significantly elevated at 8 weeks in the diabetic WKY rats and at 4 weeks in the diabetic SHRs. The blood volume significantly increased at 8 weeks in the diabetic WKY rats and remained higher thereafter, whereas it did not change in the diabetic SHRs throughout the experimental period. The left ventricular peak dP/dt was depressed in the 8-week diabetic SHRs, whereas in the diabetic WKY rats, its depression was observed at 12 weeks after diabetes onset. Histopathological studies showed that diabetic changes in ANP synthesis and hemodynamic parameters described above occurred before the cardiomyopathic histological changes. Cardiac ANP synthesis in the diabetic rats completely reverted to control levels after insulin therapy, accompanied by normalization of hemodynamic parameters. The present study indicates that 1) ANP synthesis is significantly augmented in the streptozotocin-induced diabetic rat compared with that in the normal rat, and the combination of diabetes and hypertension produces an earlier and greater effect in stimulating cardiac ANP synthesis than does either disease alone; 2) an elevation in the intraventricular filling pressure that occurs before observable cardiomyopathic histopathological alterations might be involved partially in the augmented ANP synthesis; and 3) the reversibility with insulin therapy suggests that the streptozotocin-induced alterations observed in cardiac ANP synthesis and hemodynamics result from insulin-deficient diabetes mellitus, not from cardiac toxicity of streptozotocin.

Animals↗

PubMed1990

Stimulation of rat atrial natriuretic peptide (rANP) synthesis by triiodothyronine and thyroxine (T4): T4 as a prohormone in synthesizing rANP.

Thyroid hormones have been reported to increase the secretion and synthesis of atrial natriuretic peptide (ANP) in vitro. In this study, we focused on the role of type I T4 5'-deiodinase to investigate the stimulating effects of T4 on ANP synthesis and secretion by measuring cellular content and secretion into the medium of immunoreactive rat ANP (IR-rANP) and rANP mRNA levels in cultured rat neonatal atrial myocytes. Both T3 (10(-9)-10(-7) M) and T4 (10(-8)-10(-6) M) increased cellular content and secretion into the medium of IR-rANP in a dose-dependent manner. However, these effects of T4 were completely inhibited by the addition of propylthiouracil, which selectively suppressed type I T4 5'-deiodinase activity. Methimazole, which did not alter T4 5'-deiodinase activity, had no effects on T4-induced IR-rANP increase. In the measurements of rANP mRNA levels by dot blot analysis, T3 (10(-8) and 10(-7) M) and T4 (10(-7) and 10(-6) M) increased rANP mRNA levels in the same way as they increased IR-rANP content. Although T4-increased rANP mRNA levels were also inhibited by propylthiouracil, methimazole did not alter the effect of T4. Moreover, T4-induced rANP mRNA accumulation in atrial myocytes was further stimulated by the addition of dithiothreitol, suggesting that the deiodinating activity was thiol sensitive. These data suggest that the stimulating effect of T4 on cellular IR-rANP content and rANP mRNA levels is entirely induced after it is converted to T3 by type I T4 5'-deiodinase in atrial myocytes and that T4 serves as a prohormone for T3 in synthesizing rANP.

Animals↗

PubMed1990

Synergistic effect of thyroid hormone and thyrotropin on iodothyronine 5'-deiodinase in FRTL-5 rat thyroid cells.

The effects of T3 and T4 on the iodothyronine 5'-deiodinase (5'-D) activity in FRTL-5 rat thyroid cells were investigated. T3 and T4 stimulated the 5'-D activity in a dose-dependent manner. Kinetic studies showed that the stimulation of the 5'-D by T3 was associated with an increase in maximum velocity (Vmax) in [11.9 +/- 0.2 (mean +/- SE) and 25.4 +/- 0.9 pmol I-released/mg protein.min, respectively, in control and cultured with 10(-9) M T3 for four days] but without a change in apparent Michaelis-Menten constant (Km) (94.8 +/- 5.3 nM and 105.4 +/- 12.1 nM, respectively). Furthermore, cycloheximide (5 microM) completely abolished the stimulatory effect of T3 on the 5'-D activity. T3 and T4 also enhanced the 5'-D activity stimulated by TSH in a dose-dependent manner. Kinetic studies showed that the stimulatory effect of T3 on the 5'-D stimulated by TSH was again associated with an increase in Vmax (86.0 +/- 4.0 and 166.5 +/- 1.9 pmol I- released/mg protein.min, respectively, cultured with 0.3 U/liter TSH and cultured with TSH plus 10(-9) M T3 for four days) without a change in apparent Km (114.0 +/- 7.4 nM and 111.6 +/- 12.5 nM, respectively). Cycloheximide (5 microM) completely abolished the stimulatory effect of TSH plus T3 on the 5'-D activity. There were no significant differences observed between cells cultured with TSH and with TSH plus T3 in either the intra- or extracellular cAMP contents. Furthermore, T3 enhanced the 5'-D activity stimulated by (Bu)2 cAMP. These results strongly suggest that T3 or T4 was synergistic with TSH in stimulating the 5'-D activity in FRTL-5 cells, and that cAMP production would be an important component of the synergism.

Animals↗

PubMed1990

Graves' immunoglobulin G stimulates iodothyronine 5'-deiodinating activity in FRTL-5 rat thyroid cells.

To elucidate the effect of Graves' immunoglobulin G (IgG) on iodothyronine deiodination in the thyroid, we examined the characteristics of iodothyronine 5'-deiodinating (I-5'-D) activity in FRTL-5 rat thyroid cells and the effect of Graves' IgG on its activity. FRTL-5 cells were sonicated and incubated with 0.5 mumol/L rT3 with a tracer amount of [125I]rT3 in 0.1 mol/L phosphate buffer containing 1 mmol/L EDTA and 0.5 mmol/L dithiothreitol. The released 125I- was separated by Dowex-50WX2 column and counted. The amount of I- released was tissue, incubation time, temperature, and pH dependent, strongly suggesting that the reaction is enzymatic. The activity was completely inhibited by propylthiouracil. The Km value for rT3 was approximately 0.32 microM when analyzed by Lineweaver-Burk plot. TSH, dibutyl cAMP, and Graves' IgG induced I-5'-D activity in a dose-dependent manner. However, cycloheximide (5 mumol/L) abolished the stimulating effects of these agents on I-5'-D activity. These results suggest that TSH, dibutyl cAMP, and Graves' IgG induced I-5'-D activity through the synthesis of new enzyme protein. A significant positive correlation between thyroid-stimulating antibody activity assayed by measuring cAMP production using FRTL-5 cells and I-5'-D activity induced by the Graves' IgG in 10 patients with untreated Graves' disease was observed (r = 0.79; P less than 0.01). The present findings suggest that type I iodothyronine 5'-deiodinase exists in FRTL-5 rat thyroid cells and that Graves' IgG as well as TSH stimulate the activity at least in part by activating adenylate cyclase.

Animals↗

PubMed1990

Diastolic time during static and dynamic exercise in myocardial infarction.

To evaluate the difference in the response of DT in the early phase of static (sustained weight load) and dynamic (treadmill) exercise, the relation of DT and HR was studied by ear densitography in 11 patients with myocardial infarction. None of the patients had an ischemic electrocardiographic response during exercise. Despite an increase in HR and the pressure-HR product with both types of exercise, the pressure-HR product was significantly higher at three minutes of dynamic exercise, which was associated with a significant lengthening of left ventricular ejection time. Diastolic blood pressure rose significantly during static exercise, but it remained unchanged with dynamic exercise. Electromechanical systole and HR had a linear inverse relation at three minutes of exercise, and DT and HR had a nonlinear inverse relation (DT = e7.29-0.0156 x HR, and DT = e7.07-0.0142 x HR for static and dynamic exercises, respectively). A significant prolongation of QS2 with a consequent shortening of DT (p less than 0.05) was observed in dynamic exercise. In addition to a higher pressure-HR product, the disproportionate shortening of diastole in the early phase of dynamic exercise has a potential for initiating imbalance of myocardial oxygen supply and demand.

Blood Pressure↗

PubMed1990

A sensitive and practical bioassay for thyrotropin (TSH): comparison of the bioactivity of TSH in normal subjects and in patients with primary hypothyroidism.

To study the possible correlation between the bioactivity ratios of the serum TSH and serum thyroid hormone concentrations in patients with primary hypothyroidism, the bioactivity of TSH in these patients was determined by means of a sensitive and practical bioassay and the results were compared to those in normal subjects. Sample sera were obtained from 11 patients with primary hypothyroidism and 9 normal subjects. TSH was extracted from the serum with anti-human TSH monoclonal antibody-coated tubes. The bioassay for TSH was performed by measuring the amount of cAMP released into the medium from cultured FRTL-5 cells incubated with the TSH extract. Linear relations were found between the serum TSH values, measured by the immunoassay, and the bioactivity of the TSH, measured by the present assay, in normal subjects (y = 1.13 x-0.3, r = 0.89, p less than 0.01) and in patients with primary hypothyroidism (y = 0.90 x + 0.7, r = 0.93, p less than 0.01). Moreover, the regression line in patients with primary hypothyroidism was not significantly different from that in normal subjects based on the analysis of covariance. The present findings suggest that the bioactivity of TSH is consistent with the immunoreactivity of TSH in patients with primary hypothyroidism as well as in normal subjects.

Adult↗

PubMed1990

Human chorionic gonadotropin promotes thyroid growth via thyrotropin receptors in FRTL-5 cells.

To ascertain the presence of thyroid growth-promoting activity (TGA) in the sera of pregnant women, we measured TGA in the sera of pregnant women by means of a bioassay based on [3H]-thymidine [( 3H]Tdr) incorporation in cultured rat FRTL-5 thyroid cells. Furthermore, to elucidate the mechanisms of human chorionic gonadotropin (hCG) in promoting the thyroid growth, we evaluated the effects of blocking type TSH receptor antibody (blocking IgGs) from patients with primary hypothyroidism on the activity of hCG. After the PEG-pretreated serum or the serum plus blocking IgGs was incubated for 72 h at 37 degrees C with FRTL-5 cells and [3H] Tdr, [3H] Tdr incorporated in the cells was counted. Although 9 normal pregnant women had normal TGA, two patients with hydatidiform mole, whose hCG levels were 966,500 and 497,100 IU/L, had positive TGA, but the activity showed normal when analyzed with the addition of a blocking IgG. hCG also showed a dose-dependent increase in [3H]Tdr incorporation, and it was inhibited by the addition of blocking IgGs. Furthermore, the inhibition of hCG-induced [3H]Tdr incorporation by 16 blocking IgGs correlated with their TBII and the inhibition activity of hCG-induced cAMP accumulation. Analysis by the Lineweaver-Burk plots of dose response curves of TSH- and hCG-induced [3H]Tdr incorporation showed the same inhibition pattern as with the addition of the same blocking IgGs. In conclusion, 1) hCG-related TGA exists in the sera of some patients with hydatidiform mole; and 2) hCG and the sera of some patients with hydatidiform mole promote thyroid growth, at least in a part, via TSH-receptors in FRTL-5 cells.

Adolescent↗

PubMed1990

Thyroid-stimulating activity of human chorionic gonadotropin in sera of normal pregnant women.

To ascertain the thyrotropic activity of human chorionic gonadotropin in sera of normal pregnant women, we examined the adenylate cyclase activation in the cultured FRTL-5 cells by extracted hCG from 7 normal pregnant women. hCG was extracted from the sera using anti-hCG-beta subunit monoclonal antibody-coated microwells, eluted with 2 mol/l guanidine-HCl, and reconstituted with hypotonic Hanks' solution. FRTL-5 cells were precultured in 5H medium, incubated for 2 h with the serum extracts, and the cAMP released into the medium was measured. hCG levels in serum extracts ranged from 1100 to 6800 IU/l; values corresponded to 1.4-19.8% compared with those in the original serum samples. Addition of the extracts to FRTL-5 cells resulted in significant increases in the cAMP accumulation, ranging from 9.8 to 59.0 nmol/l. cAMP levels were also increased in a dose-dependent manner by adding purified hCG as well as crude hCG and hTSH to FRTL-5 cells. These findings suggest that the thyroid gland of normal pregnant women may actually be stimulated by hCG itself.

Adult↗

PubMed1990

[An autopsy case of extra-adrenal malignant pheochromocytoma].

An autopsy case of an extra-adrenal malignant pheochromocytoma in a 34-year-old woman is reported. On laparotomy, many advanced stage malignant tumors originating from the paraganglia along the abdominal aorta were found to have invaded the lumbar vertebrae. After a partial resection, Co60 radiation therapy of the paraganglia was instituted, as well as of the metastatic lesions, with little effect. It was found that alpha-methyl-tyrosine was effective in controlling the plasma catecholamine, but had to be discontinued because of an untoward effect (anxiety). The patient subsequently developed intractable hypertension and a paralytic ileus from excess catecholamine secretion. As an alpha 1 adrenergic blocker was not effective, we had to use large doses of phentolamine to control these complications. Despite various intensive therapies, however, the patient died of heart failure resulting from 4 years of severe hypertension.

Adult↗

PubMed1990

[Epidermoid cyst of the oral floor with massive deposition of melanin in the cystic epithelium].

Dermoid cyst or epidermoid cyst of the oral cavity usually occurs in the floor of the mouth. We encountered a 21-year-old woman who had developed epidermoid cyst in the oral floor. Since infancy she had been aware of a swelling in the oral floor. Recently, the swelling began to grow larger gradually. The lesion was excised under general anesthesia by intraoral approach. The swelling was spherical in shape, measured 50 x 45 x 40 mm in size, and weighed 40 g. Histopathological examination revealed keratinized, stratified squamous epithelium on the cyst wall and marked deposition of melanin at the base of the epithelium.

Adult↗

PubMed1990

[The role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease].

To define the role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease, 967 consecutive patients referred to our laboratory since 1985 were studied. The purpose of scintigraphy has changed from diagnosing myocardial ischemia to assessing myocardial viability with the progress of coronary angioplasty. At present, thallium-201 myocardial scintigraphy has become an indispensable noninvasive method for the management of patients with ischemic heart disease.

Adolescent↗

PubMed1990

Hemodynamic response to ibopamine in acute myocardial infarction.

To determine the effects of ibopamine on hemodynamic parameters, 9 patients with cardiac dilation after acute myocardial infarction were studied. Although there were no significant changes in mean blood pressure, heart rate and rate pressure product after administration of ibopamine, cardiac index and urine volume increased significantly. These data indicate that ibopamine exerts a positive inotropic effect on the myocardium and vasodilating effect on renal vasculature without increasing myocardial oxygen consumption. However, pulmonary capillary wedge pressure increased significantly at 30 min after ibopamine and decreased to the control value at 120 min. A significant increase in heart rate was observed in 3 patients which was followed by chest pain. In addition to increase in cardiac contractile force and decrease in subendocardial perfusion from elevated left ventricular end diastolic pressure, increase in heart rate would decrease diastole time, while increase in oxygen consumption results in aggravation of ischemia especially in patients with multivessel coronary disease. From these findings it is considered that ibopamine should be administered with care to patients with multivessel coronary disease.

Aged↗

PubMed1990

[Effect of verapamil on myocardial infarct size estimated by serial 201-thallium single-photon emission tomography].

To investigate the effects of intravenous verapamil (V) in coronary thrombolytic therapy, we serially observed the time course of perfusion of the myocardium by 201-thallium (Tl) SPECT in patients who were successfully reperfused within 6 hours from the onset. 201-Tl SPECT was attempted serially on the 1st-2nd day, the 7th-10th day and 28th-30th day. In addition to this, we calculated the count ratio of radioactivity of 99mTc-PYP (CR) in the infarcted myocardium to sternum to evaluate intracellular uptake of calcium during reperfusion. The infarct size, estimated by % Defect decreased significantly in the patients treated with V, while it remained unchanged in the patients without it. In the patients with V, the left ventricular ejection fraction was more favourable, and exercise-induced ischemia determined by redistribution of 201-Tl SPECT in the chronic phase was found more frequently. CR showed no difference between reperfused myocardium irrespective of the treatment. In conclusion, verapamil was considered to enhance myocardial salvage carried out by reperfusion, and not to affect the influx of intracellular calcium into the injured myocytes.

Drug Evaluation↗

PubMed1989

Oxygen delivery, oxygen consumption and hemoglobin-oxygen affinity in acute myocardial infarction.

The interrelations of oxygen delivery (DO2), oxygen consumption (VO2) and hemoglobin-oxygen affinity assessed by P50 were investigated in 43 patients with acute myocardial infarction. As DO2 declined due to low cardiac output, a significant decrease in VO2 (r = 0.75, p less than 0.001) and a significant increase in P50 (r = -0.74, p less than 0.001) were observed. In the DO2 range between 300 and 450 ml/min/m2, in which the DO2 of 32 survivors and 11 nonsurvivors overlapped, the P50 of nonsurvivors was significantly higher than that of survivors (31.5 +/- 1.6 vs 27.9 +/- 1.5 torr, p less than 0.001), but there were no significant differences in any other oxygen transport variable. As a result of differences in P50, VO2 in this range was significantly higher in nonsurvivors compared to survivors (169 +/- 17 vs 148 +/- 13 ml/min/m2, p less than 0.001). These data suggest that a normal or increased VO2 alone does not ensure survival in patients with acute myocardial infarction, and increased P50 leads to an increase in VO2. Nevertheless, the interpretation of an increased P50 in patients with acute myocardial infarction must be made with caution, even with adequate DO2 and VO2, because it may imply a precarious oxygen transport/requirement balance in peripheral tissue and, hence, a fatal outcome.

Aged↗

PubMed1989

Immunological characterization and clinical implication of cobalamin binding protein in human gastric cancer.

Cobalamin (vitamin B12) binding protein was purified from gastric cancer extracts and from serum-free culture medium of cancer cell line KATOH-III. The molecular weight, determined by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, was 70,000 and the pI was 2.8 to 3.2. From biochemical and immunological properties, this cobalamin binding protein was considered to be an isoprotein of cobalamin R binder. Monoclonal antibodies were produced against saliva R and cobalamin binding protein in culture medium to study their antigenic determinants. Monoclonal antibody 55-D reacted to an epitope of peptide in both binders, whereas WK-1 and H-12 reacted to determinants of a carbohydrate moiety, including sialic acid, in cancer cell-derived binder. In addition, we carried out an enzyme-linked immunoassay and examined plasma levels of immunoreactive R binder in patients with gastric cancer (n = 72), benign gastrointestinal disease (n = 30), and healthy individuals (n = 40). Even in patients without liver metastasis, the level of immunoreactive R binder detected by monoclonal antibody H-12 was elevated in some patients and decreased after excision of the tumor. R binder was also elevated in cancer tissue extract. Immunoreactive binder was histochemically detected in the cytosol of cancer cells and metaplastic cells of the gastric mucosa. The present findings suggest that cobalamin R binder is de novo synthesized in gastric cancer cells and that its plasma level increases in some patients. This binding protein may be a useful diagnostic and therapeutic parameter.

Adult↗

PubMed1989

[21-hydroxylase deficiency associated with adrenal tumor: case report of two brothers].

Described herein are two brothers with 21-hydroxylase deficiency (21-OHD) associated with adrenal tumors, and these possible mechanisms are discussed. A 34-year-old male was admitted on Jan. 9, 1984 because of an enlarged and tender left breast. Physical examination revealed short stature (152 cm, 76.5 kg), gynecomastia and shortening of metacarpal bone. His testes were small (2.6 X 1.6 X 1.9 cm). Urinary excretion of 17-OHCS was within normal range (5.9 mg/day), but those of 17-KS, 17-KGS and pregnanetriol were markedly increased (44.4, 110 and 22.6 mg/day, respectively). Plasma concentrations of progesterone and ACTH and urinary excretions of estrone, estradiol and estriol were also increased. Urinary excretions of 17-KS were decreased to 11.7 mg/day and 17-KGS to 22.3 mg/day after the ingestion of 2 mg/day dexamethasone for two days. The computed tomography and a scintigraphy with 131I-Adosterol revealed a tumor in the left adrenal gland, and the adrenal arteriography revealed a neovascularity and a tumor stain in the tumor. These data indicated that the patient was suffering from both 21-OHD and the left adrenal tumor. At this point, adenoma or adenocarcinoma of the adrenal gland was suspected. The left adrenal tumor (85 g) was resected on April 10, 1984, and the pathological diagnosis was adrenal adenoma. The patient's endocrinological abnormalities, however, did not improve after the operation. Urinary excretions of 17-KS and KGS were increased to 57.9 and 108.5 mg/day, respectively, in the patient's elder brother, and 63.3 and 127.9 mg/day, respectively, in his younger brother, indicating that they also had 21-OHD. Interestingly, an adrenal tumor was diagnosed by abdominal computed tomography in the elder brother who had the same HLA typing as the present case. The three brothers had 21-OHD, and two of them had both 21-OHD and adrenal tumor. To our knowledge, this is the first report documenting the co-existence of adrenal tumors in brothers with 21-OHD. This suggests that adenoma can be one of the complications of 21-OHD, probably due to the chronic stimulation by ACTH, and that a possible linkage to HLA may exist in such cases.

Adenoma↗