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CASE REPORT
Double hit! A unique case of resistant hypertension
  1. Kristen Elizabeth DeCarlo1,
  2. Nidhi Agrawal2
  1. 1Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, NYU School of Medicine, New York City, New York, USA
  1. Correspondence to Dr Kristen Elizabeth DeCarlo, kristen.decarlo{at}northwestern.edu and Dr Nidhi Agrawal, Nidhi.Agrawal{at}nyumc.org

Summary

A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing. CT scan of the adrenals was non-localising. Adrenal venous sampling confirmed bilateral idiopathic adrenal hyperplasia. Concurrent primary hyperparathyroidism was demonstrated by elevated calcium and parathyroid hormone levels and localised by sestamibi scan. Idiopathic adrenal hyperplasia was treated medically with spironolactone. Her BP remained elevated until postparathyroidectomy. Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA making this bidirectional link unique. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.

  • adrenal disorders
  • endocrinology
  • hypertension
  • drugs: endocrine system
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Footnotes

  • Contributors Dr. Agrawal was the attending endocrinologist caring for the patient described in the case. Dr. DeCarlo completed chart review and background research to write and report this case in conjunction with Dr. Agrawal. The investigators retained full independence in the conduct of this research.

  • Funding The research reported in this case report was supported by New York University School of Medicine.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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