Discussions By Condition: I cannot get a diagnosis.

malignant hypertension

Posted In: I cannot get a diagnosis. 7 Replies
  • Posted By: Anonymous
  • June 16, 2009
  • 09:56 PM

25 year old white male 5'11'' 145 lbs cholesterol 100 total
malignant hypertension for two years. Ruled out cushings, pituitary adenoma, pheochromocytoma, hyperaldosteronism, Connes and renal arterial stenosis.
Last lab tests indicate hypopituitaryism which causes low blood pressure. Please help. Desparate.

Scrat

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7 Replies:

  • So do your BPs run low or high? Can you provide a bit more history?
    fewd4thought 126 Replies Flag this Response
  • I'm presuming that you are referring to primary hypertension. Malignant hypertension is an acute phase reaction wherein blood pressure suddenly spikes to the extent that organ damage can occur in the absence of treatment. If you've had steady high blood pressure for 2 years, this would represent primary hypertension but not malignant hypertension or hypertensive crisis. I'm not certain of where you've obtained the reference material concerning hypopituitarism, but GH deficiency as a consequence of the disorder greatly increases perturbations in the sympathetic nervous system that may be anticipated in adults with hypopituitarism and untreated GH deficiency, because the syndrome is associated with both peripheral and central factors known to modulate sympathetic traffic. In other words, hypertension in the presence of hypopituitarism would not be unexpected. If your heart rate is also increased, then it would suggest that there is regional norepinephrine spillover taking place. Serum IGF-I studies, together with TSH levels would be suggested here, together with muscle sympathetic nerve activity (MSNA). The results of these tests would indicate whether the hypopituitarism is the underlying cause for the hypertension. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • My son has been hospitalized with malignant hypertension twice, and has blood pressure as high as 280/180 regularly. His kidneys are now functioning at 30% and he has left ventricular hypertrophy. He has never done meth or other street drugs. His first hospitalization was in 2007.Two weeks ago he was in the hospital and upon admission his cortisol was low at .5 His ACTH was also low at 6. According to lab tests online this would indicate possible hypopituitarism. He had a head CT which was normal.Could he have a normal head CT and still have hypopituitarism?The doctors have ruled out Cushings, Pheochromocytoma, pituitary tumors, renal arterial stenosis, hyperaldosteronism and connes, but they think there is likely a secondary cause. If anybody has any ideas as to what could be killing my son please reply.Thanks!Scrat
    Anonymous 42789 Replies Flag this Response
  • My son has been hospitalized with malignant hypertension twice, and has blood pressure as high as 280/180 regularly. His kidneys are now functioning at 30% and he has left ventricular hypertrophy. He has never done meth or other street drugs. His first hospitalization was in 2007.Two weeks ago he was in the hospital and upon admission his cortisol was low at .5 His ACTH was also low at 6. According to lab tests online this would indicate possible hypopituitarism. He had a head CT which was normal.Could he have a normal head CT and still have hypopituitarism?The doctors have ruled out Cushings, Pheochromocytoma, pituitary tumors, renal arterial stenosis, hyperaldosteronism and connes, but they think there is likely a secondary cause. If anybody has any ideas as to what could be killing my son please reply.Thanks!Scrat
    Anonymous 42789 Replies Flag this Response
  • Okay, this in an entirely different clinical picture than what was originally posted. We now have better clarification and thank you for posting the additional information. Hypocortisolism with low ACTH would suggest secondary Addison's disease. While it can indeed be caused by something like a pituitary tumor such as an adenoma, which was ruled out in your son's case, there are other causes. Metastatic tumor, histiocytosis X, Craniopharyngioma, Sarcoidosis, Empty Sella Syndrome, Lymphocytic Hypophysitis or isolated ACTH deficiency all are among other underlying causal factors in secondary adrenal insufficiency. A sensitive screening test for Addison's disease is the rapid Cosyntropin stimulation test. 8 AM cortisol is measured and followed by intravenous administration of 250 micrograms of synthetic ACTH. Plasma cortisol is measured at 30 and 60 minutes after administration of the drug. Normal individuals produce a twofold increase in the baseline ACTH level while persons with either primary or secondary Addison's disease show a subnormal response. The problem with secondary Addison's is that paroxysmal malignant hypertension would not be among the characteristic symptoms noted in such a disorder. If possible, please provide further lab result data, particularly the pituitary profile and any other specific diagnostic tests performed. Also, if he has any medical history, particularly wherein corticosteriod therapy was provided, please indicate so in your reply. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • No history of corticosteroid treatement. No other medical history other than bleeding ulcers and inflamation last year per endoscopy.Did an ACTH stimulation test for addisons upon hospital admission- results within normal limits. Has 2 right renal arteries. Chronic dehydration, severe insomnia and feels wired. Has intermitent fast heartbeat. No evidence of aortic stenosis. Head CT normal. Chest X-ray normal. Creatinine and potassium too high. Used to have chronic hypokalemia and normal creatinine. Chloride high. Glucose high. Magnesium was too low and now too high. White blood count high. neutrophils high. absolute neutro high. Hemoglobin 14.7. Hemocrit 43.3. Platelets 200. Sodium 142.CO2 27, BUN 16, Troponin less than 0.02. Catecholamine Norepinephrine 50 epinephrine 5.0 Dopamine 50 (low). Cortisol .5 upon admission. 17.0four days later. Cortisone 71. VMA pending? Adrenocorticotropic low at 6. Thank you ever so much for your help!Scrat
    Anonymous 42789 Replies Flag this Response
  • Wondering why I haven't heard anything from you.Scrat
    Anonymous 42789 Replies Flag this Response
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