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Unexpected outcome (positive or negative) including adverse drug reactions
Case report
Resistant hypertension after shockwave lithotripsy: the rude awakening of an adrenal incidentaloma
  1. Ramon Jr Bagaporo Larrazabal1,
  2. Harold Henrison Chang Chiu2 and
  3. Mark Anthony Santiago Sandoval3
  1. 1Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines
  2. 2Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines
  3. 3Division of Endocrinology, Diabetes and Metabolism, Department of Physiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines
  1. Correspondence to Dr Ramon Jr Bagaporo Larrazabal; ramonlarrazabaljr{at}gmail.com

Abstract

A 41-year-old woman presented to the hospital because of left flank pain. CT scan of the kidneys revealed left-sided calculi and an incidental right adrenal mass, no other symptoms noted. She then underwent shockwave lithotripsy (SWL). However, immediately postoperatively, she had elevated blood pressure and remained hypertensive despite having four different medications. How SWL could have increased blood pressure could not be identified. On endocrine consult 16 months after SWL, she was found to now exhibit signs and symptoms of Cushing’s syndrome. Further workup revealed the adrenal incidentaloma to be cortisol-secreting. After undergoing right laparoscopic adrenalectomy, her blood pressure normalised, cortisol levels decreased and signs of Cushing’s syndrome gradually improved. We hypothesise that the performance of the SWL could have triggered the adenoma to ‘awaken’ from being non-functioning to cortisol-producing since this was the only intervening event. Observations of other patients are needed to validate our hypothesis.

  • adrenal disorders
  • hypertension
  • urological surgery

https://doi.org/10.1136/bcr-2020-235261

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    Footnotes

    • Contributors RBL is the primary author of the paper. MASS is the primary physician of the patient and co-author. HHCC is the co-author of the paper and provided insights into the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.