Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas.
Department of Pathology, Clinical University Hospital, Galician Healthcare Service (SERGAS), FIDIS, University of Santiago de Compostela, Travesía Choupana s/n, 15706 Santiago de Compostela, Spain.
Am J Med Sci. 2022 Jan;363(1):64-68. doi: 10.1016/j.amjms.2020.06.031. Epub 2020 Jul 3.
Adrenal medullary hyperplasia is a cause of increased secretion of catecholamines by the adrenal gland that is rarely considered among the differential diagnoses of endocrine hypertension. We report the case of a 48-year-old Hispanic woman who presented for evaluation of resistant hypertension with several episodes of hypertensive crisis. The clinical presentation, biochemical results, and abdominal computed tomography scan suggested the possibility of a pheochromocytoma; however, an iodine-123-meta-iodobenzylguanidine (I-MIBG) uptake study combined with single-photon emission computed tomography (SPECT) and computed tomography (CT) scan showed diffusely increased metabolic activity in both adrenal glands. The patient underwent left adrenalectomy, and the pathology study revealed the presence of adrenal medullary hyperplasia. After surgery, blood pressure control was achieved with one antihypertensive drug, and the patient did not have recurrent hypertensive crisis. Relevant findings obtained from a whole genomic sequence done on a whole blood DNA sample from the patient are discussed.
肾上腺髓质增生是肾上腺儿茶酚胺分泌增加的一个原因，但在内分泌性高血压的鉴别诊断中很少考虑到这一点。我们报告了一例 48 岁的西班牙裔妇女，因难治性高血压伴多次高血压危象就诊。临床表现、生化结果和腹部计算机断层扫描提示嗜铬细胞瘤的可能性；然而，碘-123-间碘苄胍（I-MIBG）摄取研究结合单光子发射计算机断层扫描（SPECT）和计算机断层扫描（CT）显示双侧肾上腺代谢活性弥漫性增加。患者接受了左肾上腺切除术，病理研究显示存在肾上腺髓质增生。手术后，患者仅用一种降压药物就控制了血压，且未再发生高血压危象。讨论了从患者全血 DNA 样本进行的全基因组序列中获得的相关发现。
