Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Signs and Symptoms

You are looking at 1 - 1 of 1 items for :

  • Dyslipidaemia x
  • Arteriosclerosis x
Clear All
Takuya Higashitani Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Takuya Higashitani in
Google Scholar
PubMed Close
,
Shigehiro Karashima Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Shigehiro Karashima in
Google Scholar
PubMed Close
,
Daisuke Aono Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Daisuke Aono in
Google Scholar
PubMed Close
,
Seigoh Konishi Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
Department of Internal Medicine, Keiju Medical Center, Nanao, Ishikawa, Japan

Search for other papers by Seigoh Konishi in
Google Scholar
PubMed Close
,
Mitsuhiro Kometani Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Mitsuhiro Kometani in
Google Scholar
PubMed Close
,
Rie Oka Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Rie Oka in
Google Scholar
PubMed Close
,
Masashi Demura Department of Hygiene, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Masashi Demura in
Google Scholar
PubMed Close
,
Kenji Furukawa Health Care Center, Japan Advanced Institute of Science and Technology, Nomi, Ishikawa, Japan

Search for other papers by Kenji Furukawa in
Google Scholar
PubMed Close
,
Yuto Yamazaki Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

Search for other papers by Yuto Yamazaki in
Google Scholar
PubMed Close
,
Hironobu Sasano Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

Search for other papers by Hironobu Sasano in
Google Scholar
PubMed Close
,
Takashi Yoneda Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Takashi Yoneda in
Google Scholar
PubMed Close
, and
Yoshiyu Takeda Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

Search for other papers by Yoshiyu Takeda in
Google Scholar
PubMed Close

Summary

Renovascular hypertension (RVHT) is an important and potentially treatable form of resistant hypertension. Hypercortisolemia could also cause hypertension and diabetes mellitus. We experienced a case wherein adrenalectomy markedly improved blood pressure and plasma glucose levels in a patient with RVHT and low-level autonomous cortisol secretion. A 62-year-old Japanese man had been treated for hypertension and diabetes mellitus for 10 years. He was hospitalized because of a disturbance in consciousness. His blood pressure (BP) was 236/118 mmHg, pulse rate was 132 beats/min, and plasma glucose level was 712 mg/dL. Abdominal CT scanning revealed the presence of bilateral adrenal masses and left atrophic kidney. Abdominal magnetic resonance angiography demonstrated marked stenosis of the left main renal artery. The patient was subsequently diagnosed with atherosclerotic RVHT with left renal artery stenosis. His left adrenal lobular mass was over 40 mm and it was clinically suspected the potential for cortisol overproduction. Therefore, laparoscopic left nephrectomy and adrenalectomy were simultaneously performed, resulting in improved BP and glucose levels. Pathological studies revealed the presence of multiple cortisol-producing adrenal nodules and aldosterone-producing cell clusters in the adjacent left adrenal cortex. In the present case, the activated renin-angiotensin-aldosterone system and cortisol overproduction resulted in severe hypertension, which was managed with simultaneous unilateral nephrectomy and adrenalectomy.

Learning points:

  • Concomitant activation of the renin-angiotensin-aldosterone system and cortisol overproduction may contribute to the development of severe hypertension and lead to lethal cardiovascular complications.

  • Treatment with simultaneous unilateral nephrectomy and adrenalectomy markedly improves BP and blood glucose levels.

  • CYP11B2 immunohistochemistry staining revealed the existence of aldosterone-producing cell clusters (APCCs) in the adjacent non-nodular adrenal gland, suggesting that APCCs may contribute to aldosterone overproduction in patients with RVHT.

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Hormone, Aldosterone, Cortisol, Renin, Condition/ Syndrome, Diabetes mellitus type 2, Hyperaldosteronism, Hyperosmolar hyperglycaemic state, Hypertension, Macronodular Adrenal Hyperplasia, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, Asian - Japanese, Country of Treatment, Japan, Diagnosis and Treatment, Signs and Symptoms, Arteriosclerosis, Collapse, Dyslipidaemia, Hypercortisolaemia, Hypertension, Renal failure, Investigation, ACTH stimulation, Adrenal scintigraphy, Adrenal venous sampling, Aldosterone (blood), Angiography, Blood pressure, Cortisol, Creatinine, Creatinine (serum), CT scan, Dexamethasone suppression, Estimated glomerular filtration rate, Glucose (blood), Glucose (blood, fasting), Haematoxylin and eosin staining, Histopathology, HOMA, Immunohistochemistry, Insulin tolerance, MRI, PET scan, Renin plasma activity, Total cholesterol, Triglycerides, Urinalysis, Intervention, Adrenalectomy, Laparoscopic adrenalectomy, Medication, Alpha-blockers, Atorvastatin, Doxazosin, DPP4 inhibitors, Insulin, Insulin Aspart, Linagliptin, Meglitinides, Nifedipine, Repaglinide, Related Disciplines, Urology, Publication Details, Case Report Type, Novel treatment
DOI:
https://doi.org/10.1530/EDM-19-0163
Volume/Issue:
Volume 2020: Issue 1
Open access