Endocrine Abstracts

Introduction: Juxtaglomerular cell tumour (JCT) or Reninoma, is a rare cause of curable secondary hypertension, usually presented as a small renal tumour and treated by tumorectomy or partial nephrectomy (PN). Minimally invasive treatment such as percutaneous radiofrequency ablation (PRFA) has gained popularity over the last decade to treat small tumors. We report the case of a woman with secondary hypertension due to JCT, successfully treated with PRFA.

Case report: Hypertension appeared at 68 years old, initially treated with Ramipril. Six months later, patient was admitted in hospital in emergency for severe hypertension (systolic blood pressure (BP): 220 mmHg) and delirium. She presented with hypokalaemia (1.9 mmol/l), hyponatremia and alkalosis. Shortly after treatment of malignant hypertension and hypokalaemia, aldosterone and renine levels were respectively 3116 pg/ml (30–146) and 4301 mUl/l (2.8–39.9), potassium was 3.5 mmol/l. In order to control BP and potassium, 3 antihypertensive drugs (Nebivololol 5 mg/d, Lercanidipine 10 mg/day and Urapidil 60 mg twice daily) and oral potassium supplements (32 mEq/d) were progressively added. Two months later aldosterone and renin levels were respectively 400 pg/mL (17.6–232) and 106 pg/mL (1.5–22.2), confirming secondary hyperaldosteronism. The CT-scan showed a 13×10 mm mass of the lower pole of the left kidney with enhancement after contrast media injection. On MRI the nodule had discreetly T2 hyposignal, T1 hyposignal, and was moderately and progressively enhanced after injection of gadolinium. Due to lower limbs oedema, Lercanidipine has been replaced by Valsartan 80 mg/d, with a mean BP at home of 135/85 mmHg. In view of the size and location of the tumour, percutaneous RFA were performed under CT-control and local anaesthesia. Pre-procedural biopsies were negative. Patient did not experiment any complication, including increase of creatinine level. Antihypertensive drugs were tapered off and stopped after the procedure: Urapidil after 48 hours, Valsartan after 2 weeks and Nebivolol after 1 month. The potassium substitution was discontinued on day 5. After 2 months, BP was 120/76 mmHg, potassium level was 4.1 mmol/l, aldosterone level was 147 pg/ml, renin level was 4.7 pg/ml. CT-scan showed scar of PRFA, no tumor was detected.

Conclusion: This case shows efficacity of PRFA to cure secondary hypertension, due to JCT, which is almost always a benign tumour. PRFA appears to be an effective alternative to PN and a minimally invasive with few per and post-intervention complication.