'Malignant' hypertension from hyperaldosteronism: a case report

Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We descri...

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Bibliographic Details
Published in:	The Pan African medical journal Vol. 30; no. 10; p. 10
Main Authors:	Baradhi, Krishna Mohan, Tran, Thao, Mittadodla, Penchala Swamy
Format:	Journal Article
Language:	English
Published:	Uganda African Field Epidemiology Network 2018 The African Field Epidemiology Network The Pan African Medical Journal
Subjects:	Abdomen Adrenal Cortex Neoplasms - complications Adrenal Cortex Neoplasms - diagnosis Adrenal Cortex Neoplasms - surgery Adrenal glands Adrenalectomy - methods adrenocortical carcinoma Adrenocortical Carcinoma - complications Adrenocortical Carcinoma - diagnosis Adrenocortical Carcinoma - surgery Aged Blood Pressure Case Report Case reports Chemotherapy Cushing syndrome Endocrine disorders Female Humans hyperaldosteronism Hyperaldosteronism - complications Hyperaldosteronism - etiology Hypertension Hypertension, Malignant - etiology Hypokalemia Hypokalemia - etiology Laboratories Lung Neoplasms - diagnosis Lung Neoplasms - secondary Lymphatic system Medical prognosis Metastasis Nephrectomy - methods Neuroendocrine tumors Potassium Recurrence secondary hypertension Tumors United States > US Arkansas Oklahoma hyperaldosteronism adrenocortical carcinoma hypokalemia Secondary hypertension
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Summary:	Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We describe a 67-year old female presented with hypertensive urgency & hypokalemia as a result of hyperaldosteronism from an 8-cm right ACC. She underwent a radical right nephrectomy with adrenalectomy that normalized her blood pressure. However, a few years later she presented again with resistant hypertension from hyperaldosteronism, raising the suspicion of recurrence of ACC. A contrast-enhanced CT scan showed a normal left adrenal gland but revealed pulmonary metastases of ACC based on a lung biopsy. Chemotherapy was complicated with side effects leading to refusal of further chemotherapy, henceforth requiring high dose of spironolactone for blood pressure control. Despite curative surgery, metastatic functional ACC should be considered in patients presenting with secondary hypertension from recurrent hyperaldosteronism, due to its high recurrence rate. Besides standard cancer surveillance after a curative surgery, meticulous monitoring of blood pressure is a simple yet crucial way to detect cancer recurrence early.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1937-8688 1937-8688
DOI:	10.11604/pamj.2018.30.10.14015