ECE2018 Poster Presentations: Adrenal and Neuroendocrine Tumours Adrenal medulla (11 abstracts)
Why is it important to screen secondary endocrine hypertension in resistant cases? Lessons from a patient with progressive renal failure
Manuel Esteban Nivelo-Rivadeneira 1 , Isabel Ramos-Gomez 2 , Maria Dolores Perez-Ramada 2 , Ana Delia Santana-Suarez 1 , Agnieszka Kuzior 1 , Paula Fernandez-Trujillo-Comenge 1 , Carmen Acosta-Calero 1 , Claudia Arnas-Leon 3 , Sara Quintana-Arroyo 3 & Francisco Javier Martinez-Martin 4
1Endocrinology & Nutrition Department, University Hospital of Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain; 2Internal Medicine Department, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain; 3Endocrinology & Nutrition Department, Hospitales San Roque, Las Palmas de Gran Canaria, Spain; 4Outpatient Hypertension Clinic, University Hospital of Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain.
Introduction: Even though most hypertensive patients have essential hypertension, in the resistant cases the prevalence of secondary hypertension is much higher; therefore its screening should be mandatory. Resistant hypertension usually causes a progressive decline of renal function if blood pressure is not adequately controlled. Such decline is often irreversible; however a timely diagnosis leading to a resolutive treatment can alleviate or even revert the progression of the renal disease.
Clinical case: A 66 year old woman had been diagnosed of essential hypertension when she was 49 years old. She was treated with a combination of Fosinopril, Telmisartan, Amlodipine and Hydrochlorothiazide but her blood pressure was usually >160/100 mmHg; she had nephrotic syndrome with proteinuria >5 g/24 h and her eGFR was deteriorating (83 ml/min/1.73 m2 in 2013, 40 ml/min/1.73 m2 in April 2017). After complaining of abdominal pain, she was diagnosed of sigmoid adenocarcinoma, and underwent successful surgical rejection. In the presurgical workup, an incidental mass measuring 4.3x1.7 cm was found on top of the left adrenal in a CT scan, and she was referred to our Endocrinology Clinic. Lab tests showed metanephrin 117 pg/ml, normetanephrin 1464 pg/ml and cromogranin A 159.9 ng/ml. A MIBG/SPECT CT showed isolated hypercaptation next to the left adrenal. After adequate preparation, on 25/04/2017 a 4.3-cm mass was resected along with the adjacent left adrenal, which was normal. The final pathology diagnosis was paraganglioma (KI-67 negative, cromogranin A positive) without extracapsular extension. One month after surgery the patient was asymptomatic with normal blood pressure (113/67 mmHg) under treatment only with Manidipine 10 mg/day. The eGFR has improved (60 ml/min/1.73 m2), albuminuria had decreased dramatically (232 mg/24 h) and cromogranin A and metanephrines were normal.
Conclusions: This case illustrates the importance of the etiologic diagnosis and treatment in secondary resistant hypertension. The patient was relentlessly progressing to end-stage renal failure but presently her blood pressure is well controlled while minimally treated, and her renal function has markedly improved.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more