Bilateral renal artery stenosis and primary aldosteronism in a diabetic patient

Extract

Sir,

The close association between diabetes mellitus and cardiovascular disease is well known, the risk of cardiovascular disease being 2–5 times greater in diabetics than in the background population.¹ Renal arteries seem to be widely involved in the macrovascular disease of diabetes, and primary aldosteronism is also a well-recognized cause of secondary hypertension. We report a diabetic woman presenting with refractory hypertension, who had coexisting bilateral atherosclerotic renal artery stenosis and aldosteronism due to bilateral adrenal hyperplasia.

A 58-year-old woman was admitted to our Department because of refractory hypertension during the last 4 months, superimposed on pre-existing and poorly controlled hypertension. The patient was completely asymptomatic. There was a 10-year history of hypertension and type 2 diabetes mellitus. Her medications comprised atenolol, irbesartan, hydrochlorothiazide, amlodipine, terazosin, ticlopidine, metformin, and glibenclamide.

Blood pressure was 230/100 mmHg, equal in both arms, and the pulse was 80 bpm. On physical examination, renal bruits were heard bilaterally. Twenty-four-hour blood pressure monitoring confirmed marked hypertension and also showed extreme dipping during night-time.