Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy.
Institute of Radiology, Department of Medicine - DIMED, University of Padua, Italy.
Am J Hypertens. 2018 Apr 13;31(5):537-540. doi: 10.1093/ajh/hpx213.
We herein report on a 20 years old woman with stage I hypertension, who was found to carry a renin-producing tumor (RPT).
Due to her young age, the patient underwent screening measurement of plasma renin and aldosterone, abdominal computed tomography (CT) angiography, and selective renal vein renin assessment to identify secondary hypertension.
The patient was screened for secondary causes of hypertension and was diagnosed with secondary aldosteronism. Therefore, she underwent an abdominal computed tomography (CT) angiography that was reported as unremarkable. Selective renal vein renin studies showed overproduction of renin in the right kidney and a re-evaluation of her CT allowed detection of an 8-mm mass in her right kidney, suggesting the presence of a RPT. Considering the technical difficulty of renal sparing surgery a CT-guided cryoablation was undertaken, which provided long-term cure of arterial hypertension and normalization of plasma active renin concentration.
RPTs usually present with a clinical phenotype featuring stage III and/or malignant hypertension and are held to be exceptionally rare. This case is unique in that it presented with stage I hypertension and a mild clinical phenotype. Moreover, to our knowledge this is the first case of RPTs shown to be safely treated with CT-guided cryoablation and found to be cured at long-term.
本研究报告了一位 20 岁的女性高血压 I 期患者，发现其患有肾素产生肿瘤（RPT）。
由于患者年龄较小，进行了血浆肾素和醛固酮、腹部 CT 血管造影和选择性肾静脉肾素评估的筛查测量，以确定是否为继发性高血压。
患者接受了继发性高血压的筛查，被诊断为继发性醛固酮增多症。因此，进行了腹部 CT（CT）血管造影，结果未见异常。选择性肾静脉肾素研究显示右肾肾素过度产生，重新评估 CT 发现右肾有 8 毫米的肿块，提示存在 RPT。考虑到保留肾单位手术的技术难度，进行了 CT 引导下冷冻消融术，长期治愈了动脉性高血压并使血浆活性肾素浓度正常化。
RPT 通常表现为 III 期和/或恶性高血压的临床表型，被认为非常罕见。该病例的独特之处在于其表现为 I 期高血压和轻度临床表型。此外，据我们所知，这是首例经 CT 引导冷冻消融术安全治疗并长期治愈的 RPT 病例。
