Primary aldosteronism is a disease entity characterized by hypertension, hypokalemia, metabolic alkalosis and muscle weakness. Aldosteronoma is the most common cause of primary aldosteronism. The prevalence of primary aldosteronism in patients with hypertension appears to be low, less than 1%. However, primary aldosteronism is the one of common cause of secondary hypertension that is one of a few potentially curable forms of hypertension by surgical treament. The malignant hypertension in primary aldosteronism is very rare and the renal vascular damage due to hypertension seldom occurs. There has been no known reports about primary aldosteronism complicated with chronic renal failure in Korea. We report the rare case of primary aldosteronism in patient with hypokalemia, metabolic alkalosis complicated with chronic renal failure due to malignant hypertension with evident nephrosclerosis.
Alkalosis ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypertension, Malignant ; Hypokalemia ; Kidney Failure, Chronic* ; Korea ; Muscle Weakness ; Nephrosclerosis ; Prevalence

Hypertensive nephrosclerosis is usually associated with chronic hypertension, which increases the risk of progressive renal disease. Among the causes of malignant hypertension, thrombotic microangiopathy is complicated and is associated with renal dysfunction at the time of diagnosis. In this case, a young man with hypertension presented with renal failure and thrombocytopenia in the emergency department. This case emphasizes the importance of early recognition of renal failure and thrombocytopenia among patients with uncontrolled hypertension.
Blood Pressure* ; Diagnosis ; Emergency Service, Hospital ; Humans ; Hypertension ; Hypertension, Malignant ; Nephrosclerosis ; Renal Insufficiency ; Thrombocytopenia ; Thrombotic Microangiopathies*

1. Present study was made to observe the plasma renin activity in the patients of benign essential hypertension, malignant hypertension, acute or chronic glomerulonephritis, liver cirrhosis with or without ascites, congestive heart failure, and massive bleeding due to various causes. 2. It was found that the substance with constrictive action on the rat colon had the hypertensive action. 3. The normotensive group showed the renin activity of 1.81+/-1.18ng/ml. 4. Benign hypertension group showed the level of 3.14+/-3.27 ng/ml which was the significantly elevated level compared to the normal group. 5. Malignant hypertensive group showed 8.47+/-9.48 ng/ml, which was not only the apparently elevated value than that of normal group, but also showed significant difference from that of benign essential hypertension. 6. The levels of 5.6+/-2.88 ng/ml and 27.5+/-12.36 ng/ml in chronic and acute glomerulonephritis respectively showed the significantly elevated level than the normal group, and the difference between the acute and chronic glomerulonephritis was also found to be significant. 7. The hepatic cirrhosis with or without ascites showed the level of 3.77+/-2.83 ng/ml and 0.80+/-0. ng/ml respectively. The value of the former was the significantly elevated compared with the normal group, and the later was lowered. 8. The level of 11.11+/-4.12 ng/ml was significantly elevated compared to that of normal group in congestive heart failure. 9. It is suggested that the renin activity assumes to be changed to the kind and the phase of the diseases and according to present data of elevated renin activity in essential hypertension, renin may play a secondary role in essential hypertension rather than to be a primary.
Animals ; Ascites ; Colon ; Glomerulonephritis ; Heart Failure ; Hemorrhage ; Humans ; Hypertension ; Hypertension, Malignant ; Liver Cirrhosis ; Plasma* ; Rats ; Renin*

Total exchangeable sodium and plasma volume were measured to evaluate role of sodium in hypertension by radioisotope 24 Na and Evans blue in 25 patients with essential hypertension, 10 with malignant hypertension, 5 with renal hypertension and 15 normal controls. The results obtained are as follows. 1. The total exchangeable sodium content was 35.8+/-3.5mEq/kg in normal controls, 35.6+/-2.7mEq/kg in essential hypertension and 36.2+/-3.5mEq/kg in renal hypertension revealing no statistical significance in difference. In malignant hypertension, it was 44.9+/-2.0mEq/kg and it was markedly elevated than in normal controls. 2. Plasma volume in normal controls was 44.0+/-4.7ml/kg. In essential hypertension there was two groups, one (group II, 35.2+/-5.6ml/kg) was slightly lower than the other (group I, 43.2+/-4.8ml/kg). In malignant hypertension, it was 56.9+/-7.5ml/kg revealing significant increase than in normal controls. 3. Changes of the total exchangeable sodium content was observed after the administration of hydrochlorothiazide 50mg in normal controls and essential hypertension. In normal controls there was no statistical significance in reduction. In essential hypertension, initially low salt group (group II) showed no significant reduction and the other group (group I) showed significant reduction with depression on blood pressure. 4. Long term therapy with hydrochlorothiazide 50mg for 2~3 months in the group of hypertension who responded well with short term therapy (group I), the contents of exchangeable sodium reduced significantly than normal controls and the antihypertensive effect was sustained. 5. The reduction of plasma volume with hydrochlorothiazide in essential hypertension are similar as changes of total exchangeable sodium. 6. In cases of low salt diet 4gm of daily salt intake, there was similar results as diuretic therapy in exchangeable sodium. 7. In patients who responded well to antihypertensive effect of hydrochlorothiazide or low salt diet (group I), salt loading of 10gm daily showed an increase of total exchangeable sodium and an elevation of blood pressure with statistical significance.
Blood Pressure ; Depression ; Diet ; Evans Blue ; Humans ; Hydrochlorothiazide ; Hypertension* ; Hypertension, Malignant ; Hypertension, Renal ; Plasma Volume* ; Plasma* ; Sodium*

Total exchangeable sodium and plasma volume were measured to evaluate role of sodium in hypertension by radioisotope 24 Na and Evans blue in 25 patients with essential hypertension, 10 with malignant hypertension, 5 with renal hypertension and 15 normal controls. The results obtained are as follows. 1. The total exchangeable sodium content was 35.8+/-3.5mEq/kg in normal controls, 35.6+/-2.7mEq/kg in essential hypertension and 36.2+/-3.5mEq/kg in renal hypertension revealing no statistical significance in difference. In malignant hypertension, it was 44.9+/-2.0mEq/kg and it was markedly elevated than in normal controls. 2. Plasma volume in normal controls was 44.0+/-4.7ml/kg. In essential hypertension there was two groups, one (group II, 35.2+/-5.6ml/kg) was slightly lower than the other (group I, 43.2+/-4.8ml/kg). In malignant hypertension, it was 56.9+/-7.5ml/kg revealing significant increase than in normal controls. 3. Changes of the total exchangeable sodium content was observed after the administration of hydrochlorothiazide 50mg in normal controls and essential hypertension. In normal controls there was no statistical significance in reduction. In essential hypertension, initially low salt group (group II) showed no significant reduction and the other group (group I) showed significant reduction with depression on blood pressure. 4. Long term therapy with hydrochlorothiazide 50mg for 2~3 months in the group of hypertension who responded well with short term therapy (group I), the contents of exchangeable sodium reduced significantly than normal controls and the antihypertensive effect was sustained. 5. The reduction of plasma volume with hydrochlorothiazide in essential hypertension are similar as changes of total exchangeable sodium. 6. In cases of low salt diet 4gm of daily salt intake, there was similar results as diuretic therapy in exchangeable sodium. 7. In patients who responded well to antihypertensive effect of hydrochlorothiazide or low salt diet (group I), salt loading of 10gm daily showed an increase of total exchangeable sodium and an elevation of blood pressure with statistical significance.
Blood Pressure ; Depression ; Diet ; Evans Blue ; Humans ; Hydrochlorothiazide ; Hypertension* ; Hypertension, Malignant ; Hypertension, Renal ; Plasma Volume* ; Plasma* ; Sodium*

PURPOSE: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. METHODS: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. RESULTS: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 +/- 66.55 microm (mean +/- SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 +/- 59.08 microm (mean +/- SD) (p = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (p = 0.002), and the mean change was 17.21 +/- 7.56. CONCLUSIONS: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness.
Blood Pressure ; Choroid* ; Humans ; Hypertension, Malignant* ; Hypertensive Retinopathy ; Intraocular Pressure ; Tomography, Optical Coherence

Mortality and morbidity of malignant hyperthermia has decreased markedly by the avoidance of succinylcholine, and the earlier detection and introduction of dantrolene. We report a fourteen-year-old boy who developed malignant hyperthermia during general anesthesia. He showed the earlier clinical signs, such as elevation of end-tidal CO2, tachycardia, and hypertension. After prompt administration of dantrolene, operation was continued with profopol and midazolam. Rhabdomyolysis and myoglobinuria followed, and were managed by hydration and alkalinization of urine. Azotemia did not occur, and he was discharged without any sequelae on the 10th postoperative day.
Anesthesia, General ; Azotemia ; Dantrolene ; Humans ; Hypertension ; Male ; Malignant Hyperthermia* ; Midazolam ; Mortality ; Myoglobinuria ; Rhabdomyolysis* ; Succinylcholine ; Tachycardia

A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.
Adult ; Glomerulonephritis/*diagnosis ; Hemoptysis/pathology ; Hemorrhage/*diagnosis ; Humans ; Hypertension, Malignant/*diagnosis ; Lung Diseases/*diagnosis ; Male

Paraganglioma is an uncommon neuroendocrine tumor of cells that originate in the autonomic nervous system. Some paragangliomas have the ability to secrete catecholamines, similar to secretions in pheochromocytoma. For this reason, paragangliomas may cause malignant hypertension in patient, upon being administered anesthesia, or during surgery, this may lead to a life-threatening condition, despite the tumor having been diagnosed before conducting the procedure. Therefore, it is important to take adequate actions for reducing the occurrence of morbidity and mortality during surgery. Here, we describe a successful anesthetic management in a patient diagnosed with retroperitoneal paraganglioma invading the iliac bone.
Anesthesia ; Autonomic Nervous System ; Catecholamines ; Humans ; Hypertension, Malignant ; Mortality ; Neuroendocrine Tumors ; Paraganglioma* ; Pheochromocytoma

Adult ; Glomerulonephritis, Membranous ; complications ; pathology ; Humans ; Hypertension, Malignant ; etiology ; Kidney ; pathology ; Male