Hypertension-induced posterior reversible encephalopathy syndrome as the presentation of progressive bilateral renal artery stenosis

SummaryPosterior reversible encephalopathy syndrome (PRES) is characterized clinically by headache, altered mental status, visual loss, and seizures. PRES is associated with neuroradiological findings characterized by white matter abnormalities, predominantly in the parieto-occipital regions of the brain. PRES is most often described in cases of hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive or anticancer therapy. We report a case of PRES associated with severe hypertension in the setting of a progressive renovascular hypertension from bilateral atherosclerotic renal artery stenosis. The pathogenesis of PRES is discussed and the importance of a prompt diagnosis and treatment is emphasized

A Rare Case of Carney-Stratakis Syndrome in a Patient With SDHA Mutation

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Incidentally discovered pheochromocytoma and aldosterone-producing adenoma in the same adrenal gland

Simultaneous occurrence of pheochromocytoma and aldosterone-producing adrenocortical tumor has been rarely reported in patients with symptoms or findings suggestive for both neoplasms. Herein, we report and discuss on a challenging case of synchronous pheochromocytoma and aldosterone-producing adenoma incidentally detected in the same adrenal gland and documented by biochemical studies and pathological examination

The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism

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Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

A 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient’s blood pressure was monitored by office measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean office blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean office blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, office and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case suggests that unilateral renal denervation may be effective in lowering blood pressure in patients with refractory hypertension and unfavorable renal arteries anatomy

A case of posterior reversible encephalopathy syndrome in the setting of post-partum preeclampsia with suppressed plasma aldosterone levels and plasma renin activity

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual loss, and seizures. PRES is associated with neuroradiological findings: white matter abnormalities, predominantly in the parieto-occipital regions of the brain. PRES has been described in association with hypertensive encephalopathy, eclampsia, renal failure, or following immunosuppressive or anticancer therapy. We report a case of PRES in a severe preeclampsia occurring in the late postpartum period, with suppressed plasma aldosterone levels and plasma renin activity. These laboratory abnormalities may be due to an apparent mineralocorticoid excess syndrome

Endovascular radiofrequency renal denervation in resistant hypertension: a single center experience

Eight patients with office blood pressure >140/90 mmHg, despite being treated with at least three antihypertensive drugs, underwent catheter-based renal denervation. Secondary hypertension was excluded in all patients. Every patient underwent follow-up at 30 days, and then every 3 months. At 6 and 12 months the median value of systolic clinic blood pressure decreased from 161 mmHg (25th-75th percentiles: 158-191 mmHg) at baseline to 144 mmHg (25th-75th percentiles: 136-153 mmHg) at follow up (P=0.012), and the median value of diastolic clinic blood pressure decreased from 102 mmHg (25th-75th percentiles: 94-122 mmHg) at baseline to 90 mmHg (25th-75th percentiles: 78-99 mmHg) at follow-up (P=0.012). The number of medications decreased from 5 (range, 2-8) at baseline to 3.3 (range, 0-6) at follow up. There was a significant decrease of left ventricular mass index from a median of 160 g/m2 (25th-75th percentiles: 147-151 g/m2) at baseline to 126 g/m2 (25th-75th percentiles 107-151 g/m2) at follow-up (P=0.043) was detected. The renal function, and metabolic and neurohumoral parameters, did not change significantly. No complications were observed

Endovascular radiofrequency renal denervation in resistant hypertension: a single center experience

Eight patients with office blood pressure >140/90 mmHg, despite being treated with at least three antihypertensive drugs, underwent catheter-based renal denervation. Secondary hypertension was excluded in all patients. Every patient underwent follow-up at 30 days, and then every 3 months. At 6 and 12 months the median value of systolic clinic blood pressure decreased from 161 mmHg (25th-75th percentiles: 158-191 mmHg) at baseline to 144 mmHg (25th-75th percentiles: 136-153 mmHg) at follow up (P=0.012), and the median value of diastolic clinic blood pressure decreased from 102 mmHg (25th-75th percentiles: 94-122 mmHg) at baseline to 90 mmHg (25th-75th percentiles: 78-99 mmHg) at follow-up (P=0.012). The number of medications decreased from 5 (range, 2-8) at baseline to 3.3 (range, 0-6) at follow up. There was a significant decrease of left ventricular mass index from a median of 160 g/m2 (25th-75th percentiles: 147-151 g/m2) at baseline to 126 g/m2 (25th-75th percentiles 107-151 g/m2) at follow-up (P=0.043) was detected. The renal function, and metabolic and neurohumoral parameters, did not change significantly. No complications were observed