Hypertension as the first and for long time period the only sign of ACTH producing pituitary adenoma: A case report
A 37-years old woman was admitted to the Department of Endocrinology 3 years ago because of hypertension with headaches. The highest value of blood pressure was 210/130 mmHg. Colour doppler of renal arteries, electrolytes, cortisol, renin, aldosteron, metanefrins and normetanefrins were normal. With perindopril 4 mg and lacidipin 4 mg/day blood pressure was well controlled. After 3 years gastroscopy was performed because of stomach discomfort and it revealed soor oesophagitis, gastritis and positive H. pylori. At that time blood test showed sideropenic anaemia. Potassium level was normal. She started to complain for headaches and precordial oppressions, swelling of hands and legs. Hypertension became uncontrolled in spite of the medications used. Laboratory results revealed low potassium levels which lead to the suspicion of primary hyperaldosteronism. Her face become oval and pletoric, with mild hirsutism. Urinary free cortisol levels were very high, and basal and dynamic functional tests suggested ACTH-dependent Cushing syndrome. Magnetic resonance imaging revealed a pituitary mass 6×9 mm with signs of necrosis. After transphenoidal resection blood pressure and potassium become normal. This case suggests that hypertension can be the first and for long time the only sign of ACTH secreting pituitary adenoma, and thus suggests a need for periodic control of urinary free cortisol.