scholarly journals Bilateral Familial Pheochromocytoma: Difficulty of Diagnosis and Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A119-A120
Author(s):  
Sohaib Khamal Doghri ◽  
Lamya Echchad ◽  
Manal Azriouil ◽  
Kaoutar Rifai ◽  
Hind Iraqi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Genetic Diseases ◽  
Secondary Hypertension ◽  
Exceptional Case ◽  
Lumbar Pain ◽  
Partial Adrenalectomy ◽  
Bilateral Pheochromocytoma ◽  
Familial Pheochromocytoma ◽  
Histological Data ◽  
Total Adrenalectomy

Abstract Introduction: Bilateral pheochromocytoma is a rare tumor, often seen in the context of a family illness. The majority of pheochromocytomas are sporadic, but they can also occur within the framework of genetic diseases (10%): MEN2, VPL, NF1, familial paraganglioma (mutation of SDHB)⋯ In the context of a familial genetic disease, the pheochromocytoma can be either unilateral or bilateral, benign in 95% of cases and malignant in 5%. It still poses several problems related to its diagnosis, genetic aspects, especially in the absence of a family history. And the criteria of malignancy, given the non-existence to date of a certain & universal criterion that judges the malignancy of the tumor. We present through this article the exceptional case of “bilateral familial pheochromocytomas with strong suspicion of malignancy”. Clinical Case: A 29-year-old lady, hypertensive since 4 years, admitted for exploration of severe secondary hypertension. She reports a triad of menard and severe lumbar pain, the somatic examination shows hypersensitivity of the flanks, a BP of 240/120 mmhg. the abdominal CT scan confirmed by an MRI show a right adrenal mass of 5 cm & another left of 1 cm, of suspicious appearance (irregular contours, areas of necrosis, heterogeneity, spontaneous density at 35 HU, a wash out at 33% with presence of L4 spinal angioma and peri-aortic lymph nodes. urinary methoxylated derivatives (UMD) returned high. The genetic study was positive VPL (on various radiological tests, there was just a spinal angioma) We retained the diagnosis of familal bilateral pheochromocytoma. In front of the clinical & radiological signs of malignancy, we decided to do: a right total adrenalectomy & a left partial adrenalectomy. Unfortunately, the blood pressure didn’t drop, and UMD were still positive; the anatomopathological study shows a pheochromocytoma with a PASS score estimated at 3 (benign!) Faced with conflicting clinical-radiological and histological data, we decided to total adrenalectomy without lymph node dissection and to closely monitor the progress. the post Op blood pressure was normalized and the UMD returned negative. Conclusion: Malignant familial bilateral pheochromocytoma is a very rare & very difficult entity to diagnose, manage & monitor. A good management requires serious collaboration between: endocrinologist, radiologist, urologist, pathologist

A Review of the Therapeutic Benefits of Moringa oleifera in Controlling High Blood Pressure (Hypertension)

2019 ◽  
Vol 5 (3) ◽  
pp. 232-245
Author(s):  
Chuku Okorie ◽  
Kola Ajibesin ◽  
Adekunle Sanyaolu ◽  
Adeena Islam ◽  
Selciya Lamech ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Moringa Oleifera ◽  
Kidney Diseases ◽  
Treatment Strategies ◽  
Secondary Hypertension ◽  
Therapeutic Benefits ◽  
Northern Regions ◽  
Long Time ◽  
Life Threatening

Moringa oleifera (M. oleifera) is an angiosperm plant that is a member of the Moringaceae family. It is a natural plant that is native to the sub-Himalayan northern regions of India, Bangladesh, Pakistan, and Afghanistan. The plant grows abundantly throughout tropical and subtropical areas of the world. For several centuries, many cultures have utilized various parts of the moringa plant as traditional medicine to treat common illnesses and control life-threatening conditions such as hypertension (HTN), diabetes, hyperlipidemia, inflammation, etc. This article reviewed the current literature on the therapeutic benefits of M. oleifera on hypertension, primarily focusing on identifying the plant’s key components and its roles in hindering the common pathophysiological pathways associated with hypertension. The number of people living with HTN has been predicted to increase to 1.56 billion worldwide by 2025 in spite of the myriads of preventive and treatment strategies available today. Therefore, it would be of great value to explore alternative complementary ways of controlling high blood pressure. HTN is commonly defined as blood pressure equal to or higher than 140/90 mm Hg. HTN itself is not a disease condition and does not elicit specific symptoms, however, if left untreated for a long time, it can lead to complicated cardiovascular diseases such as angina, congestive heart failure, myocardial infarction as well as stroke and chronic kidney diseases. Primary hypertension is diagnosed when there is no known identifiable underlying cause for the onset of the condition. Secondary hypertension is diagnosed when there is evidence of a disease or disorder triggering the onset of the condition. It is apparent that understanding the role of M. oleifera in the management of hypertension would expand the valuable strategies for the control of this condition.

scholarly journals The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 714
Author(s):  
Elisabeta Bădilă ◽  
Cristina Japie ◽  
Emma Weiss ◽  
Ana-Maria Balahura ◽  
Daniela Bartoș ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renin Angiotensin System ◽  
Drug Regimen ◽  
Secondary Hypertension ◽  
Adverse Outcomes ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

scholarly journals Blood Pressure Variability in Children With Primary vs Secondary Hypertension

2014 ◽  
Vol 16 (6) ◽  
pp. 437-441 ◽  
Author(s):  
Daniel Leisman ◽  
Melissa Meyers ◽  
Jeremy Schnall ◽  
Nataliya Chorny ◽  
Rachel Frank ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Secondary Hypertension

scholarly journals Causes of Resistant Hypertension Detected by a Standardized Algorithm

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Livia Beatriz Santos Limonta ◽  
Letícia dos Santos Valandro ◽  
Flávio Gobis Shiraishi ◽  
Pasqual Barretti ◽  
Roberto Jorge da Silva Franco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Secondary Hypertension ◽  
Control Blood Pressure ◽  
Primary Level ◽  
Standardized Protocol ◽  
Frequent Use ◽  
Drug Classes ◽  
Treatment Of Hypertension ◽  
Secondary Causes

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

Insulinemia and Blood Pressure Relationships in Patients with Primary and Secondary Hypertension, and With or Without Glucose Metabolism Impairment

1990 ◽  
Vol 3 (7) ◽  
pp. 521-526 ◽  
Author(s):  
Antonio Marigliano ◽  
Rinaldo Tedde ◽  
Leonardo Alberto Sechi ◽  
Antonella Pala ◽  
Gavino Pisanu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glucose Metabolism ◽  
Secondary Hypertension

Normal Blood Pressures and the Evaluation of Sustained Blood Pressure Elevation in Childhood: The Muscatine Study

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Linda K. Rames ◽  
William R. Clarke ◽  
William E. Connor ◽  
Mary Ann Reiter ◽  
Ronald M. Lauer
Keyword(s):  
Blood Pressure ◽  
Predominantly White ◽  
Secondary Hypertension ◽  
School Age Children ◽  
Continuing Care ◽  
School Age ◽  
Blood Pressure Elevation ◽  
Pressure Distributions ◽  
Blood Pressures ◽  
Transient Elevation

This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.

Secondary hypertension

2010 ◽  
pp. 3057-3070 ◽  
Author(s):  
Morris J. Brown ◽  
Fraz Mir
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Secondary Hypertension

The term ‘secondary hypertension’ is used to describe patients whose blood pressure is elevated by a single, identifiable cause, with an important subdivision being into reversible and irreversible causes: clinically, it is important to exclude the former, but not necessarily to find the latter. In the first two decades of life, the prevalence of secondary hypertension is greater than that of essential hypertension; thereafter, a patient is much more likely to have essential hypertension, but investigations for secondary hypertension should still be assiduous in the twenties and thirties because the alternative entails so many years of tablet-taking....

scholarly journals Therapieresistente und ‑refraktäre Hypertonie

2020 ◽  
Vol 145 (02) ◽  
pp. 87-91
Author(s):  
Rainer Düsing
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Treatment Resistance ◽  
Secondary Hypertension ◽  
White Coat Hypertension ◽  
Diagnostic Challenge ◽  
Refractory Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Apparent Resistance

AbstractHypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. The term “refractory” hypertension has been suggested for patients with uncontrolled blood pressure on ≥ 5 antihypertensive drugs including the thiazide-like diuretic chlorthalidone and the mineralocorticoid receptor antagonist spironolactone. “Pseudo resistance” especially due to white coat hypertension and non-adherence with the prescribed medication has to be ruled out to be able to identify patients with “true” treatment resistance. Therefore, before distinguishing true from pseudo resistance, the term “apparent” resistance should be used. While the prevalence of apparent resistance may be in the range of 10–15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.

Secondary Hypertension in Children and Adolescents: Novel Insights

2020 ◽  
Vol 16 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Katerina Chrysaidou ◽  
Athanasia Chainoglou ◽  
Vasiliki Karava ◽  
John Dotis ◽  
Nikoleta Printza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Children And Adolescents ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Pressure Monitoring ◽  
Cardiovascular Morbidity And Mortality ◽  
Rising Incidence ◽  
Hypertension In Children

Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

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