Abstract: SA-PO381
A Case of Reninoma in a 42-Year-Old Patient with Recurrent Strokes
Session Information
- Hypertension, CVD, and the Kidneys: Clinical Research
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Chau, Michael, Cooper University Health Care, Camden, New Jersey, United States
- Dawson, Solomon, Cooper University Health Care, Camden, New Jersey, United States
Introduction
Secondary hypertension can be due to vasculopathy, endocrinopathy, or medications. Although uncommon, secondary hypertension can be due to a reninoma leading to secondary hyperaldosteronism. We discuss a case of a patient with a reninoma and describe his clinical presentation and medical course for this rare disorder.
Case Description
A 42-year-old male with a history of hemorrhagic strokes in 2016 and 2018 with and hypertension (HTN) diagnosed 8 years prior to admission presented to the hospital for acute onset aphasia and was found to have an acute ischemic left sided stroke. Vital signs were remarkable for a blood pressure of 204/130. Hospital labs showed a serum creatinine of 0.86 mg/dL, sodium of 140, potassium of 3.7, AM renin level of 11 ng/mL/h, AM aldosterone level of 2 ng/dL, and total serum metanephrine level of 279 pg/mL. A renal artery ultrasound did not show renal artery stenosis. A CT abdomen and pelvis without contrast revealed a 2.8 cm proteinaceous cyst in the right kidney. He was discharged on Hydralazine 75 mg twice a day, Quinapril 20 mg twice a day, and Labetalol 300 mg nightly.
Repeat testing 3 months later in clinic showed an AM renin level of 46 ng/mL/h, AM aldosterone level of 71.2 ng/dL, serum creatinine of 0.87 mg/dL, sodium of 139, and potassium of 3.4. Urine metanephrine/catecholamine levels were within normal limits. His blood pressure remained uncontrolled averaging 150s systolic over 90s diastolic during his office visits and his regimen was uptitrated to Lisinopril 40 mg daily, Spironolactone 75 mg daily, Hydralazine 75 mg thrice daily, and Carvedilol 12.5 mg twice a day. He could not tolerate diuretics due to frequent urination or calcium channel blockers due to persistent headaches. An MRI of his kidneys was ordered to further assess the proteinaceous cyst and he was found to have a Bosniak 4 3.6 cm right renal lesion. He underwent a partial nephrectomy to address the mass with urology. Pathology showed a vascular-rich renal mesenchymal tumor that was compatible with a juxtaglomerular cell tumor. His blood pressure regimen improved to Lisinopril 5 mg daily 2 months after his surgery.
Discussion
Less than 100 cases of reninoma have been reported over the last 40 years. The mean age at diagnosis was 27 years with a mean duration of HTN of 47 months. Our case highlights the importance of keeping reninoma on the differential of causes of secondary HTN.