Juxtaglomerular Cell Tumor

Connor, Grace; Bennett, Carol J.; Lindstrom, Rabbe R.; Brosman, Stanley A.; Barajas, Luciano; Edelbaum, David

doi:10.1159/000181411

Cited by 23 publications

(6 citation statements)

References 17 publications

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“…As far as active renin was concerned, orthostatism increased PRA, to suggest that, even in our patient as in others [6,7,10,14,18,19], renin secretion from the tumor was probably under some degree of sympathetic control. This pattern of response, however, is not the rule in primary hyperreninism, because PRA unresponsiveness to postural stimulation has also been reported [12,19], On the other hand, acute converting enzyme inhibition by captopril did not cause the expected increment in PRA, in spite of an evident hypotensive and aldosterone-inhi biting effect, both signs of systemically effective convert ing enzyme inhibition.…”

Section: Discussionsupporting

confidence: 43%

“…However, a correct preoperative diagnosis of the disease needed to go through the crucial step of the demonstration of unilateral renin secretion from the in volved kidney, in absence of renal vascular lesions. In our experience, as of others [5,13,14,19], this proved rather hard to obtain. One plausible explanation for it is that renin lateralization may be difficult to demonstrate when renal blood flow is normal -as it was probably in our patient -in contrast with that seen in renal artery stenosis, where the reduction in renal blood flow makes it easier to obtain positive results.…”

Section: Discussionmentioning

confidence: 57%

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A Renin-Secreting Tumor

Pedrinelli¹,

Graziadei²,

Taddei³

et al. 1987

Nephron

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A 23-year-old white male was referred for hypertension resistant to triple antihypertensive treatment, with hypokalemia, hyperaldosteronism and elevated levels of circulating plasma renin activity (PRA). Renal angiography and echoscans put in evidence an avascular solid mass at the midlower level of the right kidney. Renal vein catheterization with sampling of blood from the lower branches of the right renal vein showed lateralization of renin secretion from that side. After surgical exeresis, the mass (1.0 cm) was diagnosed as a renal hemangiopericytoma on the basis of light and electron microscopy. Tumor exeresis was followed by a prompt normalization of blood pressure and plasma potassium, with a decrease in PRA and aldosterone. Two months after surgery the patient was still normotensive. Circulating levels of inactive (trypsin-activable) renin were around 60% of the total pool of plasma renin, i.e. much lower than those reported in other cases of renin-secreting tumors. After surgery, inactive and active renin fell in parallel, implying that both were secreted by the tumor. Tumoral PRA responded to postural stimulation, but was unresponsive to acute converting enzyme inhibition, suggesting that sympathetic stimuli were still operative, but the negative feedback inhibition by angiotensin II on renin secretion was lost. Acute converting enzyme inhibition by captopril dropped blood pressure; however, during long-term treatment, the drug (3 × 50 mg/day) was ineffective in terms of either blood pressure normalization or relief of secondary hyperaldosteronism. Acute calcium entry blockade by nifedipine (10 mg p.o.) caused an evident blood pressure drop.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 57%

A Renin-Secreting Tumor

Pedrinelli¹,

Graziadei²,

Taddei³

et al. 1987

Nephron

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“…These two situations can be distinguished clinically by stimulatory tests: in renovascular hypertension plasma renin is elevated by upright posture or sodium restriction in the diet and ACE inhibitors dramatically increase plasma renin activity (captopril test (Muller et al, 1986)), while in renin-producing tumors controversial results (both preservation or loss of the renin response) have been reported (Conn et al, 1972;Hollifield et al, 1975;Anderson et al, 1989;Connor et al, 1978;Baruch et al, 1984;Gordon et al, 1990). In addition, infusion of angiotensin II or the use of saralasin, an angiotensin II antagonist have given controversial results.…”

Section: Discussionmentioning

confidence: 99%

“…A Mib I antibody revealed proliferative activity in less than 5% of the tumor cells. Electron microscopy failed to show the typical rhomboid shaped electron dense granules of juxtaglomerular cells partly due to insufficient tissue preservation (Robertson et al, 1967;Conn et al, 1972;Hollifield et al, 1975;Connor et al, 1978;Lopez et al, 1991).…”

Section: Localization Proceduresmentioning

confidence: 99%

“…Histology of the tumor tissue A Hematoxylin/eosin staining showing a diffuse infiltration of the pancreas by solid strands of tumor cells with little nuclear polymorphism (magnification î 120) B Immunocytochemistry using an antibody directed against chromogranin A (CGA, dilution 1 : 2000): most of the tumor cells exhibit strong CGA immunoreactivity (magnification î50) C Most of the tumor cells exhibit a moderate argyrophilia as shown by positive Grimelius silver staining (magnification î60) tumor area and the peripheral venous circulation(Anderson et al, 1989;Connor et al, 1978), the drop in renin levels (and hypertension) after surgical removal of the tumor, high concentrations of renin in the tumor tissue as demonstrated by tissue extraction or immunocytochemical procedures or the production of these peptides in tissue culture of tumor cells.…”

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confidence: 99%

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Renin producing neuroendocrine pancreatic carcinoma - a case report and review of the literature

Langer¹,

Bartsch²,

Gerdes³

et al. 2002

Exp Clin Endocrinol Diabetes

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A 44 year old male patient presented with severe hypertension. The diagnostic work-up revealed elevated levels of plasma renin activity (about 10 times the upper limit of normal) in the presence of normal plasma aldosterone levels and serum potassium concentrations. Renovascular disease was excluded by angiography. Selective renal vein sampling did not show any renin gradient. CT-scans of the abdomen demonstrated normal morphology of the kidneys and adrenals but revealed a big mass in the pancreatic corpus and tail with infiltration of the splenic vein and the presence of enlarged local lymph nodes. The endocrine nature of the pancreatic mass was further supported by a positive octreotide scintigraphy scan. Surgical removal of the tumor by left sided pancreatectomy combined with splenectomy resulted in rapid normalization of elevated renin concentrations as well as blood pressure. Histological examination of the tumor tissue revealed the presence of a neuroendocrine pancreatic carcinoma. Highly (x 70) elevated renin levels were detected by radioimmunoassay in the tumor tissue. To our knowledge this is the first renin-producing neuroendocrine pancreatic carcinoma described in the literature. The present paper describes the case in detail and reviews the available literature on clinical symptomatology, diagnosis and treatment of renin-producing tumors.

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Blood Pressure and Hypertension in Childhood and Adolescence

Leumann

1979

Advances in Internal Medicine and Pediatrics/Ergebnisse Der Inneren Medizin Und Kinderheilkunde

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Juxtaglomerular Cell Tumor

Cited by 23 publications

References 17 publications

A Renin-Secreting Tumor

A Renin-Secreting Tumor

Renin producing neuroendocrine pancreatic carcinoma - a case report and review of the literature

Blood Pressure and Hypertension in Childhood and Adolescence

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