Reninoma as a cause of severe hypertension and poor pregnancy outcome in young woman

Danica Stamenković-Pejković; Mirjana Šumarac-Dumanović; Nebojša Bojanić; Jasmina Marković-Lipkovski; Jelena Vještica; Aleksandar Ivanović; Goran Cvijović; Ana Gligić; Uroš Bumbaširević; Svetlana Jelić; Snežana Polovina; Dragan Micić

doi:10.2298/VSP151215269S

Danica Stamenković-Pejković Clinical Center of Serbia, *Clinic for Endocrinology, Belgrade, Serbia
Mirjana Šumarac-Dumanović Clinical Center of Serbia, Clinic for Endocrinology; University of Belgrade, Faculty of Medicine, Serbia
Nebojša Bojanić Clinical Center of Serbia, Clinic for Urology, University of Belgrade, Faculty of Medicine, Serbia
Jasmina Marković-Lipkovski Clinical Center of Serbia, Institute for Pathology, University of Belgrade, Faculty of Medicine, Serbia
Jelena Vještica Clinical Center of Serbia, Institute for Pathology, University of Belgrade, Faculty of Medicine, Serbia
Aleksandar Ivanović Clinical Center of Serbia, Center for Radiology and Magnetic Resonance, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Serbia
Goran Cvijović Clinical Center of Serbia, Clinic for Endocrinology; University of Belgrade, Faculty of Medicine, Serbia
Ana Gligić Clinical Center of Serbia, Clinic for Endocrinology, Belgrade, Serbia
Uroš Bumbaširević Clinical Center of Serbia, Clinic for Urology, Belgrade, Serbia
Svetlana Jelić University of Belgrade, Faculty of Medicine, Serbia; Clinical Hospital Center “Bežanijska kosa”, Belgrade, Serbia
Snežana Polovina Clinical Center of Serbia, Clinic for Endocrinology, Belgrade, Serbia
Dragan Micić Clinical Center of Serbia, Clinic for Endocrinology; University of Belgrade, Faculty of Medicine, Serbia

DOI: https://doi.org/10.2298/VSP151215269S

Keywords: juxtaglomerular apparatus, kidney neoplasms, hypertension, fetal death, diagnostic techniques and procedures, diagnosis, differential, urologic surgical proceduresurologic surgical procedures,

Abstract

Introduction. Juxtaglomerular cell tumor (JGCT) or reninoma is a very rare cause of curable hypertension among young people. The early diagnosis is the most important based on the clinical presentation, hormonal and radiological findings observed on computed tomography (CT) and/or magnetic resonance imaging (MRI). The final confirmation of the JGCT is the lateralization of the plasma renin activity (PRA) during the selective renal venous sampling. Case report. This report presents a typical case of young women with JGCT which was manifested for the first time with severe hypertension during the pregnancy and was the reason of fetal death. After the miscarriage, the diagnosis of JGCT was made by the CT scanning and confirmed by the selective renal venous sampling. After the partial nephrectomy, the blood pressure and serum potassium normalized without the medications. Conclusion. Reninoma should be considered in the differential diagnosis as a cause of severe hypertension in pregnancy and also should be suspected in young hipertensives (especially females) with hypokalemia and secondary hyperaldosteronism after the exclusion of other causes particularly renal artery stenosis. A dynamic contrast-enhanced CT, MRI and selective renal venous sampling are the most important tools in the diagnosis of JGCT.

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