Secondary hypertension: adrenal hyperplasia

Abstract

Objetive: Evaluate the cause of Arterial Hypertension (HTN) in a patient with a hypertensive emergency and a history of probable endocrinological cause of HTN. Secondary causes of HTN are diverse, such as endocrine origins like primary aldosteronism (PA), pheochromocytoma (PC), and Cushing's syndrome. Case presentation: the case of a 71-year-old male patient with a history of HTN and a cystic lesion in the posterior mediastinum, with resection of the same in 2003, maintaining controlled HTN with Valsartan 80 mg OD until October 2023, when he presented with a hypertensive emergency expressed as subarachnoid hemorrhage (SAH). Subsequently, the HTN became difficult to manage despite the use of seven different classes of antihypertensive agents, including a long-acting thiazide diuretic and MRAs, leading to refractory arterial hypertension (RAH). HTN of probable secondary cause is suspected, evidencing positive findings for adrenal hyperplasia by MIBG uptake in both adrenal glands and the absence of adrenal and extra-adrenal tumors. Genetic tests for PC and paragangliomas did not detect variants compatible with these pathologies. The definitive diagnosis is provided by histopathological study following adrenalectomy, and in this case, they decided to defer surgical resolution due to controlled blood pressure levels with a regimen of four antihypertensives, avoiding the risks that surgery entails.