A case of renovascular hypertension with high urinary noradrenaline excretion.

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Abstract
A case report of a 32 yr old male with renovascular hypertension, suspected to be pheochromocytoma as a result of a tentative diagnosis, is given. The suspicion was based on the observation of high levels of urinary noradrenaline on several occasions with the sign of hyperreninemia. Reduction of the urinary noradrenaline [norepinephrine] levels by the administration of angiotensin converting enzyme inhibitor (SQ-14225) suggested that the high urinary noradrenaline probably resulted from hyperreninemia which reflected high plasma levels of angiotensin II. Radioisotope renography and i.v. urography strongly suggested a reduction of the right renal blood flow. The final diagnosis of renovascular hypertension was obtained on the basis of renal arteriography. The possibility of a catecholamine releasing tumor was carefully excluded by angiography before undertaking surgical treatment. The affected kidney was transplanted autogenously into the abdominal cavity. The successful operation led to a decrease in plasma renin activity, blood pressure and urinary noradrenaline excretion. Whether the primary genesis of hypertension was related to the hyperactivity of the renin-angiotensin system caused by renovascular stenosis or a noradrenaline releasing tumor was defined.