Nonfunctioning Adrenal Pheochromocytoma Incidentally Discovered Associated with Renal Oncocytoma

Pheochromocytoma (PHEO), a rare catecholamine-producing tumor, is a disease entity with variable clinical manifestations. The classic triad of symptoms are palpitations, headaches, and diaphoresis, but the signs and symptoms are wide ranging and mainly reflect the hemodynamic and metabolic actions of the catecholamines produced and secreted by the tumor. We describe the rare case of a patient affected by nonfunctioning and asymptomatic PHEO associated with the incidental discovery of renal oncocytoma, and review the literature

Plasma endothelin-1 levels in patients with resistant hypertension. effects of renal sympathetic denervation

ABSTRACT Introduction: Resistant arterial hypertension (RHT) is defined as poor controlled blood pressure (BP) despite optimal doses of three or more antihypertensive agents, including a diuretic. In the development of RHT, hyperactivity of sympathetic (SNS) and renin–angiotensin–aldosterone (SRAA) systems are involved, and SNS is a potent stimulator of vasoactive endothelin-1 (ET-1) peptide. Renal sympathetic denervation (RSD) through disrupting renal afferent and efferent nerves attenuates SNS activity. Material and methods: We carried out pilot study investigating the effect of RSD on BP and plasma ET-1 levels in consecutive 9 RHT patients (7 male and 2 female, mean age of 56 ± 13.3). Results: After 12 months of the RSD, we observed a significant reduction of BP office, 24-h ambulatory BP monitoring (ABPM) (p< 0.05, respectively), and “non-dipping” pattern (from 55% to 35%) (p< 0.05). Moreover, RSD significantly decreased plasma ET-1 levels in both renal artery (at right from 21.8 ± 4.1 to 16.8 ± 2.9 pg/ml; p ¼ 0.004; at left from 22.1 ± 3.7 to 18.9 ± 3.3 pg/ml; p ¼ 0.02). We observed positive correlations between plasma renal arteries ET-1 levels and systolic BP values at ABPM [Global-SBP (r¼ 0.58; p < 0.01), Diurnal-SBP (r ¼ 0.51; p < 0.03) and Nocturnal-SBP (r ¼ 0.58; p < 0.01), respectively]. Discussion: Our data confirmed the positive effects of RSD on BP values in patients with RHT, and showed a possible physio-pathological role of ET-1