食道破裂に伴うショックに起因する一過性両側副腎腫大をきたした1例

A case of transient adrenal swelling due to shock caused by esophageal perforation

副腎は視床下部-下垂体-副腎系と交感神経副腎髄質系の両方から構成される重要なストレス応答臓器である^1）。様々な慢性ストレスにより副腎腫大をきたすことが知られているが，急性ストレスにおいても副腎腫大をきたす可能性が示唆されている^2）。今回，食道破裂に伴うショックに起因すると思われる一過性両側副腎腫大の1例を経験したので，文献的考察を加え報告する。

We report a case of transient adrenal swelling that can be thought is caused by shock associated with esophageal perforation. The patient is a man in his 70 s. He suddenly felt chest and back pain. On esophagography, contrast leaked out of esophagus. He was diagnosed as esophageal perforation, and underwent a partial esophagectomy and an enterostomy. During surgery, his systolic blood pressure temporarily dropped to 40 mmHg. Contrast-enhanced computed tomography（CT）9 days later after surgery showed that bilateral adrenal glands were swelling, compared to those before surgery. Similar to previous reports, we suggest that adrenal gland hypertrophy can be caused by acute stress like shock.