A 36-year-old woman with Cushing syndrome was evaluated for coexisting hyperaldosteronism, which was suggested by an abnormal response of the aldosterone-to-cortisol ratio in peripheral blood to the ACTHadministration despite a low basal aldosterone-to-renin ratio. Computed tomography revealed two independent tumors in the left adrenal gland, and adrenal venous sampling indicated hyperaldosteronism in addition to hypercortisolism in the same side. Postsurgical study including immunohistochemical analysis of steroidogenic enzymes suggested one adenoma to be cortisol-producing and the other, aldosterone-producing. The comorbidity of these different hormone-producing adenomas is not rare and careful pre-surgical evaluation is necessary to avoid post-surgical exacerbation of latent hyperaldosteronism.
in research and development, to explore their perceptions of troubles and concerns about clinical research related to the Clinical Trial Act. We collected 127 comments about troubles and 149 about concerns. Text mining (co-occurrence network and hierarchical cluster analysis) was used to extract the characteristics or tendencies in these comments. The analysis extracted 18 key terms for troubles and 21 for concerns. Most troubles and concerns had to do with concrete examples of clinical research or protocols and biostatistics information. Our results emphasized the importance of clinical research support organizations, and suggested that appropriate workshops and information covering specific situations are necessary to perform clinical research under the new regime.
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