Endocrine Abstracts

High blood pressure is a common problem among patients in a Nephrology ward and outpatient clinic. However in those patients resistant to therapy, we must exclude a secondary cause. The authors present a case of a patient that was referred to our hospital due to complaints of headache, high blood pressure resistant to therapy (BP=240/130 mmHg), and images in renal ecography, which were compatible with enlarge left adrenal gland and left kidney atrophy. At admission the blood results were: Glucose=97 mg/dl; PlCr=2.5 mg/dl; BUN=33 mg/dl; Serum proteins=6.7 mg/dl; Na=129 mmol/l; K=4.7 mmol/l; Ca=13.8 mg/dl; P=2.8 mg/dl.

We performed a CAT scan and MRI, both of which showed: Atrophic left kidney, enlarge right kidney; left adrenal with nodular formation. With such a result, a pheocromocitoma was consider, but all studies were negative. A renogram with diuretic and captopril showed a mute left kidney and excretory defect in the right kidney, without any evidence of renovascular pathology. We review the blood results, and found Ca=13.8 mg/dl, PTH=480 pg/ml. The parathyroid cintigraphy revealed an adenoma of left inferior parathyroid gland. The diagnosis of PHPT was done and the patient was submitted to a partial parathyroidectomy.

Follow-up at 6 months: Calcium=9.4 mg/dl; PTH 124 pg/ml; BP=140/80 mmHg with 2 different drugs.

This case is an example of how, sometimes, a disturbance in calcium-phosphorus metabolism can be more than the consequence of chronic renal disease. Such changes can be related to a disorder that has an estimated prevalence on the order of 1% (PHPT). There is no consensus on the association between high levels of PTH and hypertension, although some authors associate hypertension with elevated PTH and hypercalcemia.