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Case ReportCase Report
Open Access

Severe hypertension secondary to renal artery stenosis and Cushings syndrome

Ali S. Alzahrani, Alya Al-Hajjaj, Jehad Al-Watban and Imaduddin Kanaan
Saudi Medical Journal April 2005, 26 (4) 668-673;
Ali S. Alzahrani
Department of Medicine (MBC 46), King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. Tel. +966 (1) 4427490. Fax. +966 (1) 4427499. E-mail: [email protected]
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Alya Al-Hajjaj
Departments of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Jehad Al-Watban
Departments of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Imaduddin Kanaan
Departments of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Abstract

We present an unusual patient who simultaneously had severe renal artery stenosis RAS and Cushings syndrome. The case highlights the difficulty of reaching a specific diagnosis of Cushings syndrome and the possible interaction between Cushings syndrome and some other concurrent illnesses that this patient had. A 37-year old man presented with severe hypertension HTN and uncontrolled diabetes mellitus DM without clear physical signs of Cushings syndrome. He was found to have severe osteoporosis, proximal myopathy, several cutaneous warts, tinea versicolor, and chronic viral hepatitis. Captopril-stimulated renal scan and renal artery angiogram revealed severe RAS. Partial balloon dilatation of RAS led to improvement in HTN. Unexpectedly, urine free cortisol 24 hour was found extremely high. Serum adrenocorticotropic hormone ACTH was also elevated and high dose dexamethasone suppression tests were inconclusive. Several imaging studies failed to localize the source of ACTH. Despite normal MRI of the pituitary gland, bilateral inferior petrosal sinus sampling IPSS localized the source of ACTH secretion to the right side of the pituitary gland and right anterior hemihypophysectomy resulted in cure of Cushings disease, HTN, DM, and tinea versicolor with significant improvement in cutaneous warts, osteoporosis, and chronic hepatitis. In conclusion, RAS and Cushings syndrome may occur together. Significant hypercortisolemia can occur without clear signs of Cushings syndrome. Controlling hypercortisolemia is of paramount importance when treating chronic infections in patients with Cushing's syndrome.

  • Copyright: © Saudi Medical Journal

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Saudi Medical Journal: 26 (4)
Saudi Medical Journal
Vol. 26, Issue 4
1 Apr 2005
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Severe hypertension secondary to renal artery stenosis and Cushings syndrome
Ali S. Alzahrani, Alya Al-Hajjaj, Jehad Al-Watban, Imaduddin Kanaan
Saudi Medical Journal Apr 2005, 26 (4) 668-673;

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Severe hypertension secondary to renal artery stenosis and Cushings syndrome
Ali S. Alzahrani, Alya Al-Hajjaj, Jehad Al-Watban, Imaduddin Kanaan
Saudi Medical Journal Apr 2005, 26 (4) 668-673;
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© 2025 Saudi Medical Journal Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.

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