scholarly journals MON-LB043 A Case of Renovascular Hypertension With Cortisol-Producing Adrenal Masses

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Takuya Higashitani ◽  
Daisuke Aono ◽  
Mitsuhiro Kometani ◽  
Shigehiro Karashima ◽  
Masashi Demura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Renal Artery ◽  
Renovascular Hypertension ◽  
Plasma Glucose ◽  
Left Renal Artery ◽  
Glucose Levels ◽  
Computed Tomography Scanning ◽  
Old Japanese ◽  
Adrenal Masses

Abstract 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 subclinical Cushing’s syndrome. A 62-year-old Japanese man had been treated for hypertension and diabetes mellitus for 10 years. He was hospitalized because of disturbance in consciousness. His blood pressure (BP) was 236/118 mmHg; pulse rate, 132 beats/min; and plasma glucose level, 712 mg/dl. Abdominal computed tomography 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. Bilateral adrenal masses were immunohistologically identified as potential sites 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, activated renin-angiotensin-aldosterone system and cortisol overproduction resulted in severe hypertension, which was managed with simultaneous unilateral nephrectomy and adrenalectomy.

scholarly journals A case of renovascular hypertension with incidental primary bilateral macronodular adrenocortical hyperplasia

2020 ◽  
Vol 2020 ◽  
Author(s):  
Takuya Higashitani ◽  
Shigehiro Karashima ◽  
Daisuke Aono ◽  
Seigoh Konishi ◽  
Mitsuhiro Kometani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Renal Artery ◽  
Renovascular Hypertension ◽  
Plasma Glucose ◽  
Severe Hypertension ◽  
Unilateral Nephrectomy ◽  
Renin Angiotensin Aldosterone System ◽  
Cell Clusters ◽  
Glucose Levels

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.

scholarly journals Leptin G-2548A Gene Polymorphism is Positively Associated with Increased Plasma Leptin and Glucose Levels in Obese Saudi Patients Irrespective Status of Blood Pressure    

2021 ◽  
Author(s):  
Lotfi S. Bin Dahman ◽  
Nasser M. Al-Daghri
Keyword(s):  
Blood Pressure ◽  
Gene Polymorphism ◽  
Plasma Glucose ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Lep Gene ◽  
Plasma Leptin ◽  
Saudi Patients

Abstract The association between LEP G-2548A gene polymorphism with increased plasma leptin and glucose levels and blood pressure in a sample of obese Saudi patients has been evaluated. This is a cross-sectional study involved 206 Saudi adult subjects (94 males and 112 females), randomly selected from the primary health care centers, Riyadh, Saudi Arabia. The study sample was categorized into three groups: 50 normotensive ND controls (age: 47.9±5.4 yr.; BMI 22.9±2.1 Kg/m2), 80 obese normotensive ND (age: 47.7±6.0 yr.; BMI 34.1±4.2 Kg/m2) and 76 obese hypertensive with T2D patients (age: 49.4±5.9 yr.; BMI: 35.1±4.7 Kg/m2). Analyses of LEP G-2548A gene polymorphism were determined using polymerase chain reaction (PCR), followed by restriction fragment length polymorphism (RFLP) with 2U of HhaI restriction enzyme. Plasma leptin and insulin levels were measured using the Luminex instrument. Fasting plasma glucose, total cholesterol, HDL-cholesterol, and triglycerides were measured using a chemical autoanalyzer Konelab machine. Also, blood pressure and anthropometric data were measured. The association analysis with metabolic parameters showed that homozygous AA of the LEP gene had significantly higher plasma glucose levels and HOMA-IR compared with homozygous GG (6.8±0.55 vs. 5.8±0.30; p< 0.04; 4.1±0.84 vs. 2.6±0.67; p=0.03) respectively. Besides, heterozygous GA had significantly higher plasma leptin levels compared with homozygous GG (40.0±2.6 vs. 29.6±2.6; P= 0.04). GA, AA, GA+AA genotypes of the LEP G-2548A gene polymorphism are more prevalent among individuals with hyperglycemia (OR= 3.7, 95% CI= 1.6 to 8.4, P= 0.001; OR= 3.2, 95% CI= 1.2 to 8.6, P= 0.03; OR= 3.5, 95%CI= 1.6 to 7.7, P= 0.001) respectively. A allele of the LEP gene is more prevalent among subjects with hyperglycemia (OR= 1.9, 95%CI= 1.2 to 3.0, P=0.006). G-2548A variant of the LEP gene may not be considered as a genetic risk factor for hypertension in Saudi obese patients. However, the genotypes (GA and AA) and -2548AA allele of this gene may represent important risk factors predisposing healthy subjects to develop T2DM irrespective of the status of blood pressure.

Successful transluminal angioplasty of renal arterial stenosis using the transcarotid approach

2002 ◽  
Vol 12 (6) ◽  
pp. 589-591 ◽  
Author(s):  
Kiyohiro Takigiku ◽  
Gengi Satomi ◽  
Satoshi Yasukochi
Keyword(s):  
Renal Artery ◽  
Renovascular Hypertension ◽  
Coronary Arteries ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Left Ventricular ◽  
Arterial Stenosis ◽  
Left Renal Artery ◽  
Ventricular Failure ◽  
Percutaneous Transluminal

We successfully performed percutaneous transluminal angioplasty to treat severe renovascular hypertension with left ventricular failure in a 5-month-old infant. Using the transcarotid approach, we dilated the stenotic left renal artery without any difficulties, using progressively larger balloons designed for dilation of coronary arteries.

Abstract 71: Novel Bach1 Modulators Increase HMOX1 and Suppress Hypertension in the Goldblatt Model of Renovascular Hypertension

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Matthew Kostura ◽  
Otis Attucks ◽  
Jareer Kassis ◽  
Suparna Gupta ◽  
Samuel Victory ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Enzyme Activity ◽  
Renovascular Hypertension ◽  
Transcriptional Repressor ◽  
Plasma Aldosterone ◽  
Lung Fibroblasts ◽  
Left Renal Artery ◽  
Dependent Manner ◽  
Sprague Dawley

We report for the first time a novel class of compounds that specifically modulate the Bach1 transcriptional repressor pathway. In cellula, the compounds selectively inhibit the activity of the transcriptional repressor Bach1 resulting in transcription of a network of antioxidant and cytoprotective genes including HMOX1. HPP-1971, a member of this class, is a potent and selective Bach1 inhibitor that induces HMOX1 > 40-fold with a potency of 408 nM in human lung fibroblasts. To assess activity in vivo, we tested HPP-1971 in the Goldblatt model of renovascular hypertension. Sprague Dawley rats were implanted with in dwelling pressure telemeter probes and subsequently underwent sham surgery or placement of a 0.25 mm silver clip around the left renal artery. HPP-1971 treatment, dosed orally at 1,3,10 and 30 mpk, commenced three days following clip surgery, and continued for 18 days. At study completion, blood pressure, clipped kidney weight, renal HMOX1 enzyme activity and plasma aldosterone levels were measured (see Table). HPP-1971 attenuated both kidney atrophy and the increase in blood pressure in a dose dependent manner with significant differences seen at 3, 10 and 30 mpk (p<.0001). HMOX1 enzyme activity in the clipped kidney increased with treatment, reaching a maximum of 5.7 ± 0.9 nM/hr/mg at 30 mpk relative to sham operated animals (p<.0001). Plasma aldosterone levels increased in 2K1C animals compared to sham controls but were reduced by HPP-1971 treatment. These findings define a novel role for Bach1 suppressors in counteracting the influence of the RAAS system on hypertension and kidney atrophy in the 2K1C model of renovascular hypertension.

scholarly journals Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

2015 ◽  
Vol 9 (4) ◽  
pp. 362
Author(s):  
Aurelio Negro ◽  
Rosaria Santi ◽  
Antonio Manari ◽  
Franco Perazzoli
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Renal Sympathetic Denervation ◽  
Caucasian Woman ◽  
Left Renal Artery ◽  
Refractory Hypertension ◽  
The Mean

A 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient’s blood pressure was monitored by <em>office</em> measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean <em>office</em> blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean <em>office</em> blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, <em>office</em> and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case suggests that unilateral renal denervation may be effective in lowering blood pressure in patients with refractory hypertension and unfavorable renal arteries anatomy.

Thromboxane A2-prostaglandin H2 and renovascular hypertension in rats

1994 ◽  
Vol 267 (5) ◽  
pp. R1190-R1197 ◽  
Author(s):  
E. H. Boussairi ◽  
J. Sacquet ◽  
J. Sassard ◽  
D. Benzoni
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Receptor Antagonist ◽  
Renovascular Hypertension ◽  
Vascular Reactivity ◽  
Thromboxane A2 ◽  
Malignant Hypertension ◽  
Receptor Blockade ◽  
Vascular Responsiveness ◽  
Goldblatt Hypertension

To evaluate the contribution of thromboxane (Tx) A2-prostaglandin (PG) H2 in two-kidney, one-clip Goldblatt hypertension (GH), 26 GH rats were chronically treated (GHT) with a specific TxA2-PGH2 receptor antagonist, CGS-22652 (30 mg.kg-1.24 h-1 sc); 28 others as well as 17 sham-clipped (SC) rats received vehicle. Twelve GH and 3 GHT rats developed malignant hypertension and died. After 6 wk of treatment, GH rats exhibited higher mean blood pressure (BP; 189 +/- 3 vs. 118 +/- 2 mmHg) and an increased vascular reactivity to the main pressor agents compared with SC rats. Chronic TxA2-PGH2 receptor blockade lowered mean BP in 13 GHT rats (125 +/- 3 mmHg) and decreased their vascular reactivity compared with GH rats. However, 10 GHT rats remained hypertensive (190 +/- 9 mmHg) and differed from the former by an increased vascular reactivity to vasopressin. It is concluded that renal artery clipping induces either benign or malignant hypertension. In benign forms, TxA2-PGH2 blockade normalizes BP through decreasing the vascular responsiveness to the main pressor agents. In malignant forms, it limits the elevation of BP and markedly reduces mortality.

scholarly journals Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mayu Watanabe ◽  
Akihiro Katayama ◽  
Hidetoshi Kagawa ◽  
Daisuke Ogawa ◽  
Jun Wada
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
Plasma Glucose ◽  
Insulin Treatment ◽  
Diet Group ◽  
Glucose Levels

Poor maternal glycemic control increases maternal and fetal risk for adverse outcomes, and strict management of gestational diabetes mellitus (GDM) is recommended to prevent neonatal and maternal complications. However, risk factors for the requirement of antenatal insulin treatment (AIT) are not well-investigated in the pregnant women with GDM. We enrolled 37 pregnant women with GDM and investigated the risk for AIT by comparing the patients with AIT (AIT group;n=10) and without insulin therapy (Diet group;n=27). The 1-h and 2-h plasma glucose levels and the number of abnormal values in 75 g OGTT were significantly higher in AIT group compared with Diet group. By logistic regression analysis, plasma glucose level at 1-h was significant predictor for AIT and the odds ratios were 1.115 (1.004–1.239) using forward selection method and 1.192 (1.006–1.413) using backward elimination method. There were no significant differences in obstetrical outcomes and neonatal complications. 1-h plasma glucose levels in 75 g OGTT are useful parameters in predicting the requirement for AIT in GDM. Both maternal and neonatal complications are comparable in GDM patients with and without insulin therapy.

scholarly journals Glucose Intolerance as Morbidity in Schizophrenia

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Sibinovic ◽  
S. Raicevic-Sibinovic ◽  
V. Slavkovic
Keyword(s):  
Diabetes Mellitus ◽  
Glucose Intolerance ◽  
Plasma Glucose ◽  
Laboratory Data ◽  
Elevated Serum ◽  
Antipsychotic Therapy ◽  
Family History Of Diabetes ◽  
Glucose Levels ◽  
Onset Diabetes ◽  
New Onset

This was an eight months prospective study.Study was active controlled in patients who were hospitalized in our Clinic. Schizophrenia was diagnosed by using PANSS scale and by using MKB 10 criteria. Laboratory data were measured at baseline, every month after therapy and at endpoint. Laboratory tests included glucose level in serum and OGTT, which were determined from blood, before breakfast and in the same hospital laboratory. Patients with family history of diabetes mellitus were excluded from the study.A total of 30 patients were recruited. the risperidone shows clinically insignificant effect on plasma glucose levels. Incidence of new onset diabetes was abaut 5% higher with olanzapine than risperidone, and the biggest increasing was in first three months. Elevated serum glucose levels have been shown with clozapine and dose-related effects were noted. We also found modest, but significant risk for increasing plasma glucose levels in patients with chlorpromazine medication. Lack of relationship between serum levels of zuclopentixol and plasma glucose has been shown. There are no apparent problems with sulpiride and with haloperidol. Medication with chlorpromazine did not show any significant modifications to blood glucose levels.The antipsychotics appear to be associated with the development of glucose intolerance, new-onset diabetes mellitus and exacerbation of existing diabetes mellitus. These disturbances in glucose metabolism have their own medical consequences. Thus, to minimize morbidity and mortality associated with the use of antipsychotic medications, close screening and monitoring for diabetes mellitus should become a priority for all clinicians treating schizophrenia patients receiving antipsychotic therapy.

Sign in / Sign up

Export Citation Format

Share Document