SummaryConn's syndrome (adrenal aldosteroneproducing adenoma) and bilateral adrenal hyperplasia are the most common causes of primary aldosteronism. The treatment of choice for patients with aldosteroneproducing adenoma is unilateral total adrenalectomy. Recurrence after adequate surgery is exceptional. We present a patient with recurrence of an aldosterone-producing adenoma in the right adrenal gland 9 years after adenomectomy of a aldosterone-producing adenoma in the same adrenal gland. We conclude that adenomectomy is not an adequate therapy for patients with adrenal aldosterone-producing adenoma.
Spontaneous renal hematoma (SRH) or Wünder-lich syndrome is rare. [1][2][3][4][5] Renal tumors and vascular diseases are the most common causes of SRH. Ultrasonography, computed tomography and magnetic resonance imaging (MRI) are useful techniques for the diagnosis and evaluation of SRH. 6 These patients usually have hypotension and acute flank pain. [1][2][3][4][5] We describe a patient with hypertension diagnosed 3 years earlier who presented with SRH and severe hypertension. CASE REPORTA 37-year-old man was admitted to the hospital because of acute left flank pain and severe hypertension. Hypertension was diagnosed 3 years earlier and he declined therapy. There was a family history of essential hypertension. He had no history of trauma or urinary tract symptoms and did not take any medications. The patient had been well until 12 hours earlier, when he had left flank pain without radiation. At entry, blood pressure was 190/120 mm Hg. A physical examination only showed pain on palpation of the left flank. No renal bruits were heard. A funduscopic examination was normal.Laboratory values were: urea 56 mg/dL, creatinine 1.2 mg/dL, sodium 143 mmol/L, potassium 4.2 mmol/L, hematocrit 45.5%, hemoglobin 147 g/L, 17300 leukocytes/mm 3 , prothrombin activity 100%, and partial thromboplastin time 29 sec (control 28-38 sec). Urine sediment revealed microhematuria without proteinuria. Ultrasonography demonstrated a liquid collection on the left kidney. Computed tomography ( Figure 1) and MRI ( Figure 2) showed this lesion to be consistent with subcapsular hematoma, without other abnormalities. Duplex ultrasonography and MRI angiography showed normal renal arteries and veins. Oral antihypertensive therapy was initiated (captopril 50 mg/8 h, doxazosin 4 mg/day, and torsemide 10 mg/day) and normotension was achieved. Hemoglobin concentration fell 2.1 points. Creatinine clearance was 123 mL/min. Radiographs of the chest, an electrocardiogram, and echocardiogram were normal. On the sixth day, he was discharged asymptomatic.Two months later (after discontinuing antihypertensive medication 2 weeks earlier), plasma aldosterone concentration and plasma renin activity were normal at 8 a.m. recumbent. The 24-hour urinaryfree cortisol, the 8 a.m. basal cortisol, and the 24-hour urinary-free catecholamine, dopamine, epinephrine, and norepinephrine were also normal. After a 6-month follow-up, he remained asymptomatic and normotensive while receiving enalapril (20 mg/day) and doxazosin (4 mg/day). Creatinine clearance and urine sediment were normal, and renal ultrasonography did not reveal abnormalities.
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