Refractory Renovascular Hypertension from Paraganglioma: A Case Report

Area of Science:

• Endocrinology
• Nephrology
• Vascular Surgery

Background:

• Secondary hypertension diagnosis and management can be challenging.
• Renovascular hypertension and catecholamine-secreting tumors (pheochromocytomas, paragangliomas) are known causes.
• The rare co-occurrence of these conditions requires careful consideration.

Purpose of the Study:

• To report a unique case of a young woman with recurrent renovascular hypertension.
• To highlight the diagnostic challenge posed by a paraganglioma as the underlying cause.
• To describe a successful multi-modal treatment strategy.

Main Methods:

• A young woman presented with recurrent hyper-reninemic hypertension post-renal artery stenosis angioplasty.
• Investigation revealed an ipsilateral renal artery aneurysm and a compressing paraganglioma.
• Treatment included repeat angioplasty, aneurysm coil embolization, and paraganglioma resection.

Main Results:

• The patient achieved sustained normotension for 6 years post-intervention without antihypertensive medication.
• Initial improvement after angioplasty suggested renal artery stenosis as a primary driver.
• The paraganglioma was identified as the ultimate underlying cause.

Conclusions:

• Paraganglioma should be considered in cases of persistent or recurrent renovascular hypertension.
• A strategic approach combining angioplasty, embolization, and surgical resection is effective.
• This case underscores the importance of identifying rare underlying causes for complex hypertension.