New-Onset Resistant Hypertension in a Newly Diagnosed Prostate Cancer Patient

2019 ◽  
Vol 32 (12) ◽  
pp. 1214-1217
Author(s):  
Nattawat Klomjit ◽  
Daniel J Rowan ◽  
Andrea G Kattah ◽  
Irina Bancos ◽  
Sandra J Taler
Keyword(s):  
Prostate Cancer ◽  
Plasma Renin Activity ◽  
Resistant Hypertension ◽  
Prostate Gland ◽  
Plasma Renin ◽  
Renin Activity ◽  
Ectopic Acth Syndrome ◽  
Chronic Hypertension ◽  
Ectopic Acth ◽  
New Onset

Abstract BACKGROUND New onset resistant hypertension in a previously stable patient with chronic hypertension should lead to consideration of secondary causes. Electrolyte abnormalities are useful clues for identifying some common causes, especially mineralocorticoid excess. CASE PRESENTATION We report the case of a 69-year-old man who developed severe resistant hypertension despite the use of 6 antihypertensive medications, including diuretics. He had metabolic alkalosis and hypokalemia with suppressed plasma renin activity and serum aldosterone. Concurrently, he was diagnosed with small cell neuroendocrine carcinoma of the prostate gland, a rare form of prostate cancer. Despite absence of typical Cushingoid features, investigation confirmed the diagnosis of ectopic adrenocorticotropic hormone (ACTH) syndrome from neuroendocrine prostate cancer. Because of the severity of his hypercortisolism, he underwent urgent bilateral adrenalectomy for hormonal and symptomatic control. Blood pressure improved significantly and he was dismissed with a single antihypertensive agent. Unfortunately, the patient died from his cancer 1 month later. CONCLUSION Primary and secondary hyperaldosteronism are usually diagnosed based on measurements of aldosterone and plasma renin activity. However, if plasma renin activity and aldosterone are both low, rare causes of mineralocorticoid excess such as ectopic ACTH syndrome should be entertained.

scholarly journals Plasma Renin Activity Predicts the Improvement in Resistant Hypertension after Percutaneous Transluminal Renal Artery Angioplasty

2016 ◽  
Vol 55 (23) ◽  
pp. 3421-3426
Author(s):  
Hyuma Daidoji ◽  
Yoshiaki Tamada ◽  
Saya Suzuki ◽  
Ken Watanabe ◽  
Taku Shikama ◽  
...  
Keyword(s):  
Plasma Renin Activity ◽  
Renal Artery ◽  
Resistant Hypertension ◽  
Plasma Renin ◽  
Renin Activity ◽  
Percutaneous Transluminal

Abstract 15037: Hyperreninemic Aldosteronism in Caucasian and African-American Patients With Apparent Resistant Hypertension

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rajat Kalra ◽  
Lama Ghazi ◽  
David A Calhoun ◽  
Suzanne Oparil ◽  
Tanja Dudenbostel
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
African American ◽  
Sleep Apnea ◽  
Plasma Renin Activity ◽  
Systolic Blood Pressure ◽  
Resistant Hypertension ◽  
Plasma Renin ◽  
Renin Activity ◽  
Obstructive Sleep

Introduction: While primary aldosteronism (PA) is a recognized and relatively well-defined cause of resistant hypertension (RHTN), there is a relative paucity of data defining patients with hyperreninemic aldosteronism (HA) and RHTN. Hypothesis: We sought to identify characteristics of patients with HA and compare them to patients with and without PA within a large cohort of patients with RHTN. Methods: We analyzed 1236 RHTN patients who were referred to our Hypertension Clinic with and underwent complete biochemical work-up including plasma aldosterone concentration, plasma renin activity, and 24-hour urinary aldosterone. Demographics, antihypertensive drug regimen, comorbidities, biochemical parameters and evaluation for secondary RHTN, where indicated, were evaluated. Hyperreninemic aldosteronism was defined as plasma renin activity >1 ng/mL*hr, aldosterone-renin-ratio of ≈ 8 or more, and 24-hour urinary aldosterone >12 mcg/24h. Results: In 128 eligible patients with resistant hypertension and HA, the mean age was 52.9±12.1 years with 56% being males (Table). Systolic and diastolic blood pressures were 149.2±22.0 and 87.9±15.5 mm Hg, respectively. Significant numbers of HA patients had co-morbid obesity (63.3%) and obstructive sleep apnea (44.9%). Compared to patients with PA, patients with HA had statistically significant lower proportions of patients with African-American race and systolic blood pressure. Compared to all RHTN patients, HA patients had lower mean age and systolic blood pressure, but were more likely to be male and have obstructive sleep apnea. Conclusions: Resistant hypertension due to hyperreninemic aldosteronism appears to predominantly affect obese, middle-aged males. Patients with HA causing RHTN have distinct differences from PA patients with RHTN. More investigation is required to identify appropriate treatment protocols for this poorly defined subset of patients with RHTN.

PERIPHERAL AND RENAL VEIN PLASMA RENIN ACTIVITY IN COARCTATION OF THE AORTA

PEDIATRICS ◽  
1970 ◽  
Vol 45 (2) ◽  
pp. 254-259
Author(s):  
William B. Strong ◽  
Robert E. Botti ◽  
Daniel R. Silbert ◽  
Jerome Liebman
Keyword(s):  
Plasma Renin Activity ◽  
Postoperative Period ◽  
Renal Vein ◽  
Coarctation Of The Aorta ◽  
Plasma Renin ◽  
Renin Activity ◽  
Chronic Hypertension ◽  
Patients Âgés ◽  
Transient Elevation

Fifteen patients (ages 4 to 21 years) with coarctation of the aorta were studied. Ten patients were catheterized prior to surgery and both peripheral and renal vein plasma renin activity (PRA) were measured. Twelve patients were operated upon and peripheral PRA was measured pre-operatively and during the acute (postoperative day 0 to 10) and long-term postoperative (M = 112 days) period. Three children, not as yet operated upon, have been catheterized. Prior to catheterization, each received a sodium restricted diet (less than 500 mg NaCl) for 48 hours. The peripheral plasma renin activity was within the range of normal both preoperatively (18 ± 10 ng/ml) and long-term postoperatively (12 ± 5 ng/ml) p > 0.1 . The three patients who received sodium restriction prior to catheterization showed borderline to moderately elevated peripheral and renal vein PRA, suggesting that the renin apparatus responded to appropriate stimulation. During the acute postoperative period, each patient had a transient elevation of peripheral PRA. This elevation might be a partial stimulus to aldosterone production in the acute postoperative period. There was no correlation between peripheral PRA and blood pressure levels in the postoperative period. It was concluded that the renin-angio-tensin system does not play a significant role in maintaining the chronic hypertension which is associated with coarctation of the aorta.

VARIATIONS IN PLASMA RENIN ACTIVITY AND URINARY ALDOSTERONE EXCRETION IN NORMAL SUBJECTS AFTER SALT RESTRICTION AND ACUTE PITUITARY INHIBITION WITH 6-DEHYDRO-16-METHYLENE HYDROCORTISONE

1971 ◽  
Vol 67 (1) ◽  
pp. 159-173
Author(s):  
A. Peytremann ◽  
R. Veyrat ◽  
A. F. Muller
Keyword(s):  
Plasma Renin Activity ◽  
Salt Intake ◽  
Plasma Renin ◽  
Normal Subjects ◽  
Inhibitory Effect ◽  
Renin Activity ◽  
Sodium Balance ◽  
Experimental Conditions ◽  
Salt Restriction ◽  
Aldosterone Production

ABSTRACT Variations in plasma renin activity and urinary aldosterone excretion were studied in normal subjects submitted to salt restriction and simultaneous inhibition of ACTH production with a new synthetic steroid, 6-dehydro-16-methylene hydrocortisone (STC 407). At a dose of 10 mg t. i. d. this preparation exerts an inhibitory effect on the pituitary comparable to that of 2 mg of dexamethasone. In subjects maintained on a restricted salt intake, STC 407 does not delay the establishment of an equilibrium in sodium balance. The increases in endogenous aldosterone production and in plasma renin activity are also similar to those seen in the control subjects. A possible mineralocorticoid effect of STC 407 can be excluded. Under identical experimental conditions, the administration of dexamethasone yielded results comparable to those obtained with STC 407.

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