title: Malignant hypertension in a patient with primary aldosteronism with elevated active renin concentration.
abstract: A 40-year-old male, with a past history of hypertension but receiving no medical treatment, was referred. He manifested malignant hypertension (190/130 mmHg; Keith-Wagener III), renal dysfunction (serum creatinine, 3.8 mg/dl), and elevated plasma aldosterone (450 pg/ml) and active renin concentration (ARC, 104 pg/ml). His blood pressure was controlled with multiple antihypertensive agents and ARC thus decreased (4.3 pg/ml), but aldosterone remained elevated. Abdominal magnetic resonance imaging (MRI) revealed a right adrenal adenoma, and aldosterone-producing adenoma was confirmed by adrenal venous sampling. Primary aldosteronism very rarely develops to malignant hypertension, and even in that case ARC is suppressed. Therefore this is a rare case of primary aldosteronism complicated with malignant hypertension and high ARC.
authors.affiliation: Department of Internal Medicine, School of Medicine, Keio University, Tokyo.
authors.forename: K
authors.initials: K
authors.lastname: Oka
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: T
authors.initials: T
authors.lastname: Nakazato
authors.forename: T
authors.initials: T
authors.lastname: Suzawa
authors.forename: K
authors.initials: K
authors.lastname: Fujiwara
authors.forename: T
authors.initials: T
authors.lastname: Saruta
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000150:complications* / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000097:blood / Q000150:complications* / Q000601:surgery; D000328:Adult; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications* / Q000601:surgery; D006974:Hypertension, Malignant / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012083:Renin / Q000097:blood*
chemical_list: D000959:Antihypertensive Agents; D000450:Aldosterone; D003404:Creatinine; D012083:Renin