Venkateswaran Ramanathan, Hamide Abdoul, Dorairajan Lalgudi Narayanan, Basu Debdatta
Department of Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India.
BMJ Case Rep. 2013 May 15;2013:bcr2012008367. doi: 10.1136/bcr-2012-008367.
A 25-year-old lady presented with hypertensive encephalopathy. She also had chronic refractory hypertension for the past 7 years. Workup revealed persistent hypokalaemia with metabolic alkalosis suggesting hyperaldosteronism. Hyperaldosteronic states such as renal artery stenosis, Conn's syndrome and Liddle's syndrome were ruled out. Her plasma renin activity was high. Contrast-enhanced CT of the abdomen showed a 1.9×2 cm heterogeneously enhancing lesion in the anterior aspect of the right kidney suggesting a possibility of reninoma. The benign tumour was resected by a nephron-sparing surgery. Histopathology suggested a juxtaglomerular cell tumour. Anti-hypertensive drugs were completely withdrawn postoperatively.
一名25岁女性因高血压脑病就诊。她在过去7年中还患有慢性难治性高血压。检查发现持续性低钾血症伴代谢性碱中毒,提示醛固酮增多症。肾动脉狭窄、原发性醛固酮增多症和利德尔综合征等醛固酮增多状态均被排除。她的血浆肾素活性很高。腹部增强CT显示右肾前部有一个1.9×2厘米的不均匀强化病灶,提示肾素瘤的可能性。通过保留肾单位手术切除了这个良性肿瘤。组织病理学提示为球旁细胞瘤。术后完全停用了抗高血压药物。