Coexisting renal artery aneurysm and adrenal adenoma in resistant hypertension.

MOTS CLÉS Hypertension artérielle secondaire ; Anévrisme artériel rénal ; Adénome de Conn ; A 58-year-old woman presented with resistant hypertension and hypokalaemia. Biological primary hyperaldosteronism was detected: aldosterone to renin ratio, 37.5; 24-hour urine aldosterone excretion, 25 g. Computed tomography (Fig. 1) diagnosed a right adrenal adenoma (26mm diameter) coexisting with a homolateral distal renal artery aneurysm (11.7mm diameter), confirmed by three-dimensional angiography (Fig. 2). Renal artery ultrasound was performed to eliminate blood flow acceleration into the aneurysm, which could induce hypertension. Blood pressure was stabilized after adrenal surgery and limited aneurysm growth. Coexistence of non-atheromatous arterial disease and adrenal adenoma is infrequent. A cause or effect relationship is difficult to prove because these anomalies are often discovered simultaneously and association may be accidental. This is the first published case of renal artery aneurysm and aldosterone-producing adenoma. Primary aldosteronism has also been described in nine cases of renal artery stenosis, six of aortic dissection (one with coronary aneurysms) and one of multiple intracranial aneurysms. Experimental data show that aldosterone modifies parietal elastin and collagen rate, leading to myocardial and vascular fibrosis. A rat model of hypertension-induced cerebral aneurysms suggests that aldosterone hypersecretion contributes partly to cerebral aneurysm pathogenesis. In our report, difficult-to-control hypokalaemia had been