MyMedR

Secondary hypertension: a condition not to be missed

Sukor N

Postgrad Med J, 2011 Oct;87(1032):706-13.

PMID: 21746730 DOI: 10.1136/pgmj.2011.118661

Hypertension is a chronic disorder which often entails debilitating cardiovascular and renal complications. Hypertension mostly arises as a complex quantitative trait that is affected by varying combinations of genetic and environmental factors. Secondary hypertension has been encountered with increasing frequency. The common causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary aldosteronism, phaeochromocytoma, and Cushing's syndrome. The detection of a secondary cause is of the utmost importance because it provides an opportunity to convert an incurable disease into a potentially curable one. Early identification and treatment will provide a better opportunity for cure, prevent target organ damage, reduce socioeconomic burden and health expenditure associated with drug costs, and improve patients' quality of life. Hence, it is a condition not to be missed.

Matched MeSH terms: Adrenal Gland Neoplasms/complications*

Cystic neuroblastoma with colonic fistula

Thajunnisa bte Hassan Mohd, Yip CH

Pediatr Radiol, 1988;18(5):406.

PMID: 3050845

Neuroblastoma is the most common malignant tumour in infancy originating in about 70% of cases in the adrenal gland. Haemorrhage and necrosis is often seen in neuroblastoma but cyst formation is uncommon. Fistulous communication between an adrenal cystic neuroblastoma and the large bowel has never to our knowledge been reported before.

Matched MeSH terms: Adrenal Gland Neoplasms/complications*

Fulltext Periadrenal inflammatory myofibroblastic tumour: half a decade before cure

Abdul Ghani R, Mohamed Shah FZ, Hanafiah M, Abdul Aziz M

BMJ Case Rep, 2019 Feb 01;12(2).

PMID: 30709882 DOI: 10.1136/bcr-2018-225687

A 30-year-old ex-smoker with a background history of childhood asthma presented with worsening shortness of breath despite receiving high doses of oral corticosteroid for pemphigus vulgaris which was diagnosed 5 years earlier. A high-resolution CT examination of the thorax reported non-specific bronchiectatic changes and revealed an incidental suprarenal mass. A subsequent CT scan confirmed a large adrenal mass with areas of necrosis and calcification. Serum renin and aldosterone, urinary catecholamine and 5-hydroxyindoleacetic acid were within normal limits. Surgical intervention was delayed due to difficulty in optimising preoperative respiratory functions. He finally underwent a midline laparotomy for removal of the tumour. Histopathological examinations revealed extrapulmonary inflammatory myofibroblastic tumour arising from the periadrenal soft-tissue, with presence of normal adrenal gland. He showed immediate improvements of his asthmatic symptoms and pemphigus vulgaris following the surgery. His oral steroid was rapidly reduced and he achieved complete remission 2 months later.

Matched MeSH terms: Adrenal Gland Neoplasms/complications

Fulltext Renal cell carcinoma in a von Hippel-Lindau syndrome: when should phaeochromocytoma be anticipated?

Azarisman SM, Nor Azmi K

Singapore Med J, 2007 Aug;48(8):779-82.

PMID: 17657389

A 39-year-old man was diagnosed with von Hippel-Lindau syndrome, which was associated with retinal haemangioblastoma, cervical cord haemangioblastoma and bilateral renal cell carcinoma. He subsequently underwent an arterial embolisation and cervical laminectomy, following a spinal angiogram of the cervical lesion. He also had a right radical nephrectomy, with no perioperative complications. However, on admission for the left radical nephrectomy, he was noted to have preoperative hypertension. Further investigation revealed an enlarged left adrenal gland on abdominal computed tomography scan and raised urinary catecholamines. We discuss the risk of renal cell carcinoma and phaeochromocytoma arising concomitantly in von Hippel-Lindau syndrome, and how best to investigate and manage them.

Matched MeSH terms: Adrenal Gland Neoplasms/complications*

Fulltext Utility of alpha-blockade in a hypotensive pheochromocytoma patient with myocardial infarction

Wahab NA, Zainudin S, AbAziz A, Kamaruddin NA

Med Princ Pract, 2015;24(1):96-8.

PMID: 25428406 DOI: 10.1159/000369021

OBJECTIVE: The aim of this case study is to emphasize the importance of α-blockade in managing a rare complication of an untreated pheochromocytoma.

CLINICAL PRESENTATION AND INTERVENTION: A 41-year-old man with previous bilateral pheochromocytoma presented with chest pain. He was suffering from cardiac failure and persistent hypotension requiring an inotrope. Cardiac markers, an electrocardiogram and an echocardiogram confirmed acute myocardial infarct with poor ejection fraction and global hypokinesia. An (18)F-fluorodeoxyglucose PET/CT scan showed progressive left suprarenal and organ of Zuckerkandl pheochromocytomas. Blood pressure stabilisation proved challenging but was achieved by titrating an incremental dose of α-blocker against a tapering inotropic dose.

CONCLUSION: This case showed the efficacy of an α-blocker despite persistent hypotension in a patient with pheochromocytoma-induced cardiomyopathy.

Matched MeSH terms: Adrenal Gland Neoplasms/complications

Endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone production as a rare cause of ocular hypertension

Khaw KW, Jalaludin MY, Suhaimi H, Harun F, Subrayan V

J AAPOS, 2010 Aug;14(4):356-7.

PMID: 20637667 DOI: 10.1016/j.jaapos.2010.04.009

Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.

Matched MeSH terms: Adrenal Gland Neoplasms/complications*

Fulltext Diffuse neonatal haemangiomatosis: a rare cause of haemorrhagic shock and refractory coagulopathy in the newborn

Rohana J, Boo NY, Hayati AR, Baizura J

Med J Malaysia, 2002 Sep;57(3):364-7.

PMID: 12440278

A term newborn infant developed hypovolaemic shock shortly after birth. She was pale with gross hepatomegaly. She required multiple boluses of intravenous fluids, blood products as well as inotropic support. Blood investigations showed persistent thrombocytopenia, anaemia and disseminated intravascular coagulopathy (DIC). She also developed heart failure. She finally succumbed on the eleventh day of life. Autopsy revealed haemangiomatosis involving the liver, lungs, gastrointestinal tract, kidneys and adrenals.

Matched MeSH terms: Adrenal Gland Neoplasms/complications*

Fulltext Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma

Ng SM, Abdullah WA, Lin HP, Chan LL

Southeast Asian J Trop Med Public Health, 1999 Mar;30(1):149-53.

PMID: 10695803

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Matched MeSH terms: Adrenal Gland Neoplasms/complications

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