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Endocrine Abstracts (2017) 49 EP170 | DOI: 10.1530/endoabs.49.EP170

1Endocrinology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Ganaria, Spain; 2Endocrinology Department, Hospital Vithas Santa Catalina, Las Palmas de Gran Ganaria, Spain; 3Outpatient Hypertension Clinic, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Ganaria, Spain.


Clinical Case: A 39-year-old woman was referred to our Hypertension Clinic for workup after three episodes of TIA with SBP >180 mmHg in the last 6 months. Diagnosed and treated of hypertension and hypokaliemia since she was 15 years old, no secondary cause had been searched. She was treated with Telmisartan/Amlodipine/Hydrochlorothiazide 80/10/25 mg plus Carvedilol 12.5 mg BID and potassium supplements. She had no history of diabetes or dyslipidemia and did not smoke. Height was 168 cm, weight 63 kg, IMC 22.3 kg/m2, office BP 142/88 mmHg, HR 72 bpm. The physical exam was otherwise normal.

Treatment was changed to Diltiazem/Doxazosin for 3 weeks. Lab: normal including TSH and metanephrines, except venous pH 7.51, Cr 1.23 mg/dl, CKD-EPI eGFR 57 ml/min/1.73 m2, albuminuria 139 mg/g Cr, aldosterone 792 ng/ml, PRA 58 ng/ml per h, normal ratio (13.7).

Funduscopy: stage 2 hypertensive retinopathy, brain RMN: scattered white matter microinfarctions, heart US: normal function, mild LVH (LVMI 92 g/m2). Chest X-ray and abdominal US: normal.

AngioCT excluded renal artery sclerosis, but showed a 12 mm subcapsular mass in the right kidney. The adrenals were normal.

Renal venous sampling for renin: Peripheral 628 U/l (normal < 42), Left renal vein 645 right renal vein 3120 U/l; right/left ratio 4.8. Laparoscopic nodulectomy was performed; a encapsulated 14 mm adenoma with clean margins was obtained. It tested positive for renin.

Diagnosis: Secondary aldosteronism due to reninoma, resistant hypertension and target-organ damage (retinopathy, brain microinfarctions and TIAs, stage IIA CKD with microalbuminuria, LVH). Two months after surgery the patient is normotensive with manidipine 10mg/day: aldosterone, ARP, K+, venous pH and albuminuria are normal.

Commentary: Reninoma is rare but probably infradiagnosed, and a long diagnostic delay is not unusual. Even with well-controlled BP, it may cause severe organ damage due to hyperaldosteronism. Thus, it should be included in the workup of secondary hypertension.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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