ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 3 (70 abstracts)
Your young patient has severe, resistant hypertension? Do not treat her without a workup!
Manuel Esteban Nivelo-Rivadeneira 1 , Agnieska Kuzior 1 , Paula Maria Fernandez-Trujillo-Comenge 1 , Ana Delia Santana-Suarez 1 , Carmen Acosta-Calero 1 , Esperanza Perdomo-Herrera 2 , Alba Lucia Tocino-Hernandez 3 & Francisco Javier Martinez-Martin 4
1Endocrinology & Nutrition Dpt, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain; 2Alcaravaneras Primary Healthcare Center, Las Palmas de Gran Canaria, Spain; 3Cono Sur Primary Healthcare Center, Las Palmas de Gran Canaria, Spain; 4Outpatient Hypertension Clinic, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Introduction/Aim: Secondary hypertension is often undiagnosed or misdiagnosed as essential in young people. We hereby present a challenging case, in order to raise awareness about this problem.
Material and methods: Review of the patient’s clinical record and of the relevant literature.
Results: A previously healthy 22 year old woman complained of frequent non-pulsatile holocraneal headaches for 6 months; they were attributed to anxiety and poor sleep, and she was offered paracetamol and NSAIDs without further exploration. One night she was admitted to the emergency room with excruciating headache; her blood pressure was 237/132 mmHg. She was prescribed multiple antihypertensive treatments which proved ineffective, and was finally referred to our Outpatient Hypertension Clinic for secondary hypertension workup. The only relevant finding was plasma normetanephrine 1950 pg/mL (x 10 UNL), with normal metanephrine. Abdominal CT showed a heterogeneous 6 cm retroperitoneal mass in the aortocaval space and normal adrenals. Even though the MIBG scan was negative, paraganglioma was suspected, and after presurgical preparation it was laparoscopically removed. The pathological diagnosis was paraganglioma with low malignancy risk (Ki67<2%). The patient remains asymptomatic and normotensive without medication and her metanephrines are normal.
Conclusions: Severe secondary hypertension may remain undiagnosed in young people, therefore signs such as unexplained headache must be pursued. An accurate diagnosis is essential in order to achieve control and eventually a cure. The sensitivity of the MIBG scan, while high for pheochromocytoma (>90%), is lower for paraganglioma (67%), hence a negative scan does not exclude the diagnosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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