An Usual Case of Hypertension

Dr. Brooke presented a rare case of symptomatic hypertension as the presenting symptom of metastatic carcinoid. Per Dr. Brooke's presentation, some take aways:

  • Suspect and evaluate for secondary hypertension in patients with:
    1. Severe hypertension or treatment resistant hypertension (not well controlled on three different classes of antihypertensive including a diuretic)
    2. New hypertension in a young patient without other risk factors such as obesity, family history.
    3. Severe hypertension with signs of end-organ damage
    4. Evidence of renovascular hypertension such as sustained creatinine elevation >50 percent after ace/arb initiation, asymmetric/atrophic kidney, abdominal bruit, etc
  • In addition to renovascular hypertension, your differential should include intrinsic kidney disease, primary aldosteronism, pheochromocytoma, Cushing's syndrome, aortic coarctation, OSA, and drugs (NSAIDs, OCPs, illicits).
  • Carcinoid syndrome is characterized by intermittent flushing episodes and secretory diarrhea. Bronchospasm and carcinoid heart disease are also often seen. Though rarely presenting with hypertension as in this case, the typical presentation is flushing with hypotension (which can be prolonged and life threatening in ‘carcinoid crisis’ provoked by anesthesia).