Double hit! A unique case of resistant hypertension.
BMJ Case Rep
; 20172017 Dec 22.
Article
en En
| MEDLINE
| ID: mdl-29275380
ABSTRACT
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosteronerenin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing. CT scan of the adrenals was non-localising. Adrenal venous sampling confirmed bilateral idiopathic adrenal hyperplasia. Concurrent primary hyperparathyroidism was demonstrated by elevated calcium and parathyroid hormone levels and localised by sestamibi scan. Idiopathic adrenal hyperplasia was treated medically with spironolactone. Her BP remained elevated until postparathyroidectomy. Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA making this bidirectional link unique. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.
Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Espironolactona
/
Diuréticos
/
Hiperparatiroidismo Primario
/
Hiperaldosteronismo
/
Hipertensión
Límite:
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
BMJ Case Rep
Año:
2017
Tipo del documento:
Article
País de afiliación:
Estados Unidos