PT  - JOURNAL ARTICLE
AU  - Kristen Elizabeth DeCarlo
AU  - Nidhi Agrawal
TI  - Double hit! A unique case of resistant hypertension
AID  - 10.1136/bcr-2017-221530
DP  - 2017 Dec 21
TA  - BMJ Case Reports
PG  - bcr-2017-221530
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2017-221530.short
4100  - http://casereports.bmj.com/content/2017/bcr-2017-221530.full
AB  - 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.