A 14-year-old woman was diagnosed with AHT when she was first admitted to a pediatric hospital with blood pressure (BP) of 210/120mmHg, headaches and hypokalemia.
With the suspicion of secondary hypertension, several studies were conducted.
Renal ultrasound, echocardiography and catheterization of the aorta and renal arteries showed no abnormalities.
The dosages of plasma renin activity (RPA) and plasma aldosterone (PA) were elevated twice.
Urine levels of vanillylmandelic acid and plasma levels of TSH, free T4 and T3 were normal.
She was discharged with angiotensin-converting enzyme inhibitors and medicated blocker, but did not return to control.
At 19 years of age, she consulted in another hospital for hypertension and was pregnant for eight weeks, so she was hospitalized in intensive care.
Good fetal health, BP 200/110mmHg and hypokalemia were determined, starting treatment with clonidine and alpha methyl dopa.
Renal ultrasound showed regular nodular formation of 45 mm in diameter in the lower pole of the left kidney, compatible with angiomyolipoma on ultrasound.
Plasma renin activity and PA were elevated.
She continued on outpatient treatment with labetalol and nifedipine.
At 19 weeks of gestation she was admitted for a day care center with a diagnosis of retained abortion and uterine curettage was performed.
Four days later, the patient was discharged from the hospital.
Two years later, being treated with enalapril, losartan and amlodipine, she was admitted to the daycare of our hospital with occipital headache and muscle weakness of several days of evolution.
BP was 220/140mmHg.
In his initial studies, hypokalemia of 2mEq/l, plasmatic creatinine of 0.6mg/dl and plasma urea of 25mg/dl were detected. The renal ultrasound showed a solid pole abdominal CT, contrasted solid sector
Renal artery Doppler and echocardiography showed no abnormalities.
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a Presumptive diagnosis of hypertension secondary to renal tumor, due to high levels of renina, and having ruled out other secondary causes HTA in previous studies, it is decided to perform a previously controlled nephrectomy of the affected kidney
Pathological examination revealed an encapsulated 5.5x4.5cm tumor with hemorrhagic aspect, with white fibrotic areas.
Microscopically, the tumor lesion was found to consist of medium-sized cells, medium-sized nuclei, with diffuse vesicles, with irregular chromatin, some inconspicuous nucleoli and other mild mononuclear eosinophilic cytoplasm.
No cellular atypia, mitosis or necrosis were found.
Tumor cells were positive for vimentin and showed strong and diffuse positivity for CD34.
The observation at the ultrastructural level allowed the recognition of cells with intracytoplasmic granules with different degrees of electrolyte disturbance, surrounded by membranes.
As for the morphology, varied from voiding to elongated shapes, acquired some forms with rectilinear shapes and stood out some of them an electron zygotic form presents a structure marked by great magnification.
Findings linked to juxtaglomerular cell tumor (YCT), allowing to corroborate the clinical suspicion.
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pharmacological treatment. the patient's BP decreased slowly and simultaneously antihypertensive drugs were withdrawn, evolving asymptomatic, normotensa, with normal levels of serum renin, aldosterona and potassium.
