Hiromasa Otsuka

Subtype prediction in primary aldosteronism: measurement of circadian variation of adrenocortical hormones and 24-h urinary aldosterone.

Currently, adrenal venous sampling (AVS) is the only reliable method to distinguish unilateral from bilateral hyperaldosteronism in primary aldosteronism (PA). However, AVS is costly and time‐consuming compared with simple blood tests. In this study, we conducted a retrospective study to determine whether circadian variation in plasma adrenocortical hormone levels (i.e. aldosterone, cortisol and ACTH) and a 24‐h urinary aldosterone could contribute to the clinical differentiation between unilateral hyperaldosteronism (UHA) and bilateral hyperaldosteronism (BHA).

Scoring System for the Diagnosis of Bilateral Primary Aldosteronism in the Outpatient Setting before Adrenal Venous Sampling

The only reliable method for subtyping primary aldosteronism (PA) is adrenal venous sampling (AVS), which is costly and time‐consuming. Considering the limited availability of AVS, it would be helpful to obtain information on the diagnosis of bilateral hyperaldosteronism (BHA) from routine tests. We aimed to establish new, simple criteria for outpatients to diagnose BHA from PA before AVS.

Edwardsiella tarda Bacteremia with Psoas and Epidural Abscess as a Food-borne Infection: A Case Report and Literature Review

Edwardsiella tarda is commonly isolated from aquatic environments and a variety of animals. We present the first case of E. tarda bacteremia with psoas and epidural abscess. The patient was a 65-year-old woman with recurrent gastric cancer who had frequently consumed raw fish and grilled eel. She was successfully treated with antimicrobials and surgery. We also review reports published in English regarding E. tarda bacteremia in Japan and the experience at our hospital. On the basis of this review, we conclude that the major underlying disease leading to E. tarda bacteremia is malignancy and that the gastrointestinal tract is the most commonly affected organ. The overall mortality rate due to E. tarda bacteremia in our review was 38.1% (8/21). Although E. tarda bacteremia is rare, clinicians should be aware of this fatal food-borne infection.

Plasma adrenocorticotropic hormone but not aldosterone is correlated with blood pressure in patients with aldosterone‐producing adenomas

Although plasma aldosterone concentration (PAC) varies depending on primary aldosteronism (PA) subtypes, patients with different subtypes may have similar blood pressure (BP). The authors hypothesized that hormones other than aldosterone might influence BP in PA patients. A total of 73 PA cases, including 30 cases of aldosterone‐producing adenomas (APAs), 29 cases of bilateral hyperaldosteronism, and 24 control cases of essential hypertension were enrolled retrospectively. The authors examined the levels of aldosterone, cortisol, renin, and adrenocorticotropic hormone (ACTH) measured at 12 am, 6 am, 12 pm, and 6 pm and BP in the early morning (6 am to 7 am), late morning (9 am to 11 am), and early evening (5 pm to 7 pm). Results showed no statistically significant correlation between PAC and BP in the patients with PA; however, early and late morning systolic BP strongly correlated with ACTH at 6 am in patients with APA. These results suggest that hormones other than aldosterone, such as ACTH, may affect BP in patients with APA.

Adiponectin Receptor gene Polymorphisms are Associated with Kidney Function in Elderly Japanese Populations

Aim: Adiponectin exhibits its biological effects through adiponectin receptors (AdipoR1 and AdipoR2), which are distributed in the kidneys, and activation of those receptors could prevent or ameliorate diabetic nephropathy. This study aimed to evaluate the associations between AdipoR single nucleotide polymorphisms (SNPs) and kidney function in an elderly Japanese population. Methods: A total of 271 elderly Japanese volunteers underwent anthropometric and laboratory tests (cystatin C-based eGFR and total and high molecular weight adiponectin levels at baseline and a follow-up visit). Genotype data were obtained for the selected 7 and 5 AdipoR1 and AdipoR2 SNPs, respectively. Results: In a cross-sectional analysis at baseline, we found a significant association between the AdipoR2 SNP rs12230440 and kidney function; eGFRcys tended to increase as the number of carriers of T alleles increased after adjustment for covariates and Bonferroni correction, although the association of the SNP and annual eGFR decline could not be identified in the longitudinal data. Regarding the variants rs16850797, rs11061925, and rs10773983, each of the allele G, allele C, and allele G showed nominally significant associations with higher eGFRcys. However, this failed to reach significance after Bonferroni correction. Conclusion: Here, an AdipoR2 SNP was associated with kidney function, suggesting that the effects of this polymorphism on adiponectin receptor may affect kidney function in the elderly Japanese population.

Bilateral Milian's Ear Sign of Erysipelas

A 76-year-old man presented with fever, and pain in his right ear. Physical examination revealed tender edematous, erythema, and a few vesicles of the right ear, along with facial involvement (Picture 1, 2). Laboratory examination showed neutrophilic leukocytosis. The next day, his left ear and face showed a tender light-colored erythema (Picture 3). After treatment with intravenous ceftriaxone, his symptoms fully resolved. Serum IgM using an enzyme immunoassay for both varicella-zoster virus and herpes simplex virus was negative. Finally, a clinical diagnosis of bilateral ear erysipelas was made. Erysipelas is a common infection involving the upper dermis and lymphatics, whereas cellulitis involves the deeper dermis and subcutaneous fat (1). Ear involvement is called Milian’s ear sign, and it is a feature distinguishing erysipelas from cellulitis, because the pinna has no deeper dermis and subcutaneous tissue (2). Bilateral ear erysipelas is rare, but it should be considered in the differential diagnosis when encountering patients presenting with red ears.

Pasteurella multocida chest wall abscess without wounds

A 79-year-old Japanese man presented to our hospital with an 18day history of fever and right-sided chest pain. The patient had undergone surgery for rectal cancer 2 years previously. Although he had three pet cats in his home, he had no history of cat bites, scratches, or licks. On examination, his blood pressure was 92/57 mmHg and temperature was 37.1 °C; a soft subcutaneous mass without obvious wounds was noted in the right-sided chest (Fig. 1). Laboratory data revealed leukocytosis (33.3 × 10/μL with 94.5% neutrophils) and elevated C-reactive protein levels (11.7 mg/dL). On admission, contrast-enhanced computed tomography revealed a subcutaneous multilocular abscess in the right-sided chest (Fig. 2). Piperacillin–tazobactam (4.5 g every 8 h) was empirically administered, and surgical drainage was performed. Although the abscess culture grew Pasteurella multocida, the two sets of blood cultures obtained on admission grew no microorganisms. Based on the results of susceptibility tests, the antimicrobial therapy was changed to ampicillin–sulbactam (3 g every 6 h). The patient was discharged on day 22, and the antimicrobial therapy was changed to oral amoxicillin (750 mg/day). After a 9-week antimicrobial course, the patient recovered without any obvious sequelae. P. multocida is a non-motile, facultatively anaerobic, gram-negative coccobacillus, which is a part of the microbiota of domesticated and wild animals (particularly cats and dogs) [1]. It can cause human infections, generally as a result of cat and dog bites, scratches, and licks [2]. However, our patient had no such animal contact. This case highlights that P. multocida infections can occur without bites, scratches, or licks. Although noting the history of animal contact is important, physicians should be aware of the potential risk of P. multocida infections in cat and dog owners without a history of such contact. Fig. 1. Photograph taken on admission, which shows a subcutaneous mass in the rightsided chest.