A case of primary aldosteronism associated with renal artery stenosis and preclinical Cushing's syndrome.
We identified a left adrenal tumor, left renal atrophy, and left renal artery stenosis (RAS) in a 52-year-old man by MRI/magnetic resonance angiography (MRA) during evaluation of hypertension. Laboratory tests revealed hypokalemia, a high plasma aldosterone concentration (PAC), low plasma renin activity (PRA), and normal plasma cortisol. An excessive response of aldosterone and cortisol to adorenocorticotrophic hormone (ACTH) was found upon selective sampling of the left adrenal vein. Selective renal venous sampling showed a left/right renal venous PRA ratio of 1.7. A dexamethasone (8 mg) suppression test showed insufficient suppression of cortisol. We diagnosed this patient as having aldosterone-producing adrenal adenoma (APA) associated with renovascular hypertension (RVH) and preclinical Cushing's syndrome. As an initial treatment, percutaneous transluminal renal angioplasty was performed. Postoperatively, the patient's blood pressure decreased. One month later, the tumor was removed by complete laparoscopic left adrenalectomy. Postoperatively, blood pressure decreased further and both PAC and PRA were normalized. However, antihypertensive therapy could not be completely stopped. The renal dysfuntion that occurred prior to treatment seemed to prevent complete normalization of blood pressure.
Tsunoda
Kazuo
K
Division of Hypertension and Diabetes Mellitus, Sendai Social Insurance Hospital, Sendai, Japan. tsunodak@ace.odn.ne.jp
Abe
Keishi
K
Yamada
Masaaki
M
Kato
Taro
T
Yaoita
Hiraku
H
Taguma
Yoshio
Y
Goto
Yasuo
Y
Ioridani
Naomasa
N
D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D000792:Angiography; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006977:Hypertension, Renal / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging