PP.39.18

Abstract

Objective: Hypertension (HT) is an ubiquitous condition with an estimated global prevalence of 30%. Essential HT accounts for the majority of cases but a secondary cause can be identified in 5–20% of patients. The ethiology of secondary HT is diverse and includes rare conditions such as juxtaglomerular tumours (JGT). JGT are exceedingly rare: to date there are only 100 cases described worldwide. Most frequently, women between 20 and 30 years of age are affected and the final diagnosis which is based on pathology findings requires a high clinical awareness. Design and method: We describe the case of a 22 year old Caucasian woman, referred to a Hypertension Outpatient clinic at a tertiary reference centre with the provisional diagnosis of secondary HT. When first assessed, she was being treated with a calcium channel blocker, direct renin inhibitor and diuretic (spironolactone) with inadequate blood pressure (BP) control. Target organ damage at presentation included concentric left ventricular hyperthrofy and proteinuria. Further investigation revealed normal catecholamine levels, hypokalaemia and slightly elevated renin levels (234 pg/mL) which were attributed to treatment with a renin antagonist. Results: A renal angio-computed tomography (CT) showed normal renal arteries and a small nodule on the right kidney but was otherwise unremarkable. Despite escalation of treatment with full dose quadruple regimen, BP remained persistently high. Renine levels were repeated and found to be exceedingly raised (3400 pg/mL). Angio-CT was also repeated showing the same nodule previously described which remained unchanged. Conclusions: The hypothesis of JGT was considered and the patient underwent successful laparoscopic tumorectomy with apparently free surgical margins. Anatomopathological examination confirmed the diagnosis. During the post-operative period, a rapid decline in BP was observed. At 4-month follow-up, renin levels have steadily declined (40pg/mL) and the patient remains normotensive without any treatment.