Approach to the Patient: Reninoma

Area of Science:

• Nephrology
• Endocrinology
• Oncology

Background:

• Reninoma is a rare, functional tumor of juxtaglomerular cells.
• It secretes renin, causing renin-angiotensin-aldosterone system (RAAS) hyperactivation.
• This leads to secondary hyperaldosteronism, severe hypertension, and hypokalemia.

Purpose of the Study:

• To describe the optimal diagnostic and management strategies for reninoma.
• To differentiate reninoma from primary aldosteronism and renovascular hypertension.
• To highlight surgical resection as the ideal curative treatment.

Main Methods:

• Review of clinical presentation, biochemical findings, and imaging characteristics of reninoma.
• Discussion of differential diagnoses, including primary aldosteronism and renovascular hypertension.
• Outline of current management approaches, emphasizing surgical tumor excision.

Main Results:

• Reninoma diagnosis is often prompted by screening for primary aldosteronism due to lack of plasma renin suppression.
• Renovascular hypertension is a key differential diagnosis.
• Fewer than 200 cases reported, with a 2:1 female predilection, often in childbearing age.

Conclusions:

• Reninoma is a curable cause of secondary hyperaldosteronism.
• Optimal management involves accurate diagnosis through imaging and biochemical workup.
• Surgical resection is the preferred curative treatment, especially given contraindications for medical management in pregnancy.