Refractory Renovascular Hypertension from Paraganglioma: A Case Report

BACKGROUND Accurate diagnosis and effective management of secondary hypertension can be challenging. Renovascular hypertension is a common etiology of secondary hypertension. Pheochromocytomas and paragangliomas are neuroendocrine tumors that secrete catecholamines, which are rarer causes of secondary hypertension. The combination of these 2 conditions is even rarer, but should not be overlooked. CASE REPORT Here, we present the case of a young woman with hyper-reninemic hypertension caused by unilateral renal artery stenosis, which recurred despite percutaneous transluminal renal angioplasty. An ipsilateral renal artery aneurysm was found as a complication at the time of recurrence of renal artery stenosis. Ultimately, a paraganglioma compressing the right renal artery was identified as the underlying cause. Following a successful second balloon angioplasty for renal artery stenosis, coil embolization for renal artery aneurysm, and subsequent surgical resection of the paraganglioma, the patient remained normotensive for 6 years without requiring antihypertensive medication. The decrease in plasma renin activity after percutaneous transluminal renal angioplasty and the subsequent improvement in hypertension prior to tumor resection suggest that renal artery stenosis was the primary cause of her hypertension. CONCLUSIONS Although rare, paraganglioma must be included as a potential cause of renovascular hypertension, particularly in cases with persistent or recurrent renal artery stenosis. Because of the concomitant renal artery aneurysm, we prioritized percutaneous coil embolization to reduce the risk of aneurysm rupture during tumor resection. This strategic approach allowed us to safely resect the paraganglioma while minimizing potential perioperative complications.