Acute Onset Of Refractory Hypertension

1270 Words6 Pages
INTRODUCTION: Acute onset of refractory hypertension in an otherwise young, healthy patient should immediately raise suspicion for secondary (non-idiopathic) etiologies. This case represents a scenario of secondary hypertension due to Cushing’s syndrome stemming from an ectopic ACTH-producing bronchial carcinoid tumor in a young, active duty sailor. PATIENT PRESENTATION: A 23 year-old otherwise healthy African American active duty male admitted directly from Endocrinology clinic for expedited work-up of suspected Cushing’s syndrome. Patient had been treated by his primary care provider for acute-onset hypertension, but had escalated rapidly to use of three antihypertensive agents within 6 months. Other than tobacco dependence (1/3 pack per day), patient had no known pertinent personal or family medical history. Patient was referred to Endocrinology due to refractory hypertension (190/100s on three agents) and signs of truncal obesity (30 lbs despite active lifestyle), moon facies, buffalo hump and violaceous striae concerning for Cushing’s syndrome. He also reported symptoms of generalized fatigue, limb weakness, lower extremity edema, easy bruising, nocturia, insomnia, and irritability. Patient was found to have elevated ACTH (252-290) with non-suppressible cortisol levels upon dexamethasone suppression testing at 1-mg (32.7) and 8-mg (37.56). Adjunctive studies included thyroid function tests, renin:aldosterone ratios, plasma metanephrines, 24-hour urine
Open Document