The PRC and PAC were re-evaluated during the follicular phase of the menstrual cycle with the same methods, and elevated PRC values of 219.2 μIU/ml and 437.2 μIU/ml were evident in both the supine and upright positions, respectively, with normal PAC values of 22.5 pg/dl in the supine position and 32.3 pg/dl in the upright position (Table 1). The PRC (chemiluminescence immunoassay, DiaSorin Ltd, accuracy: relative deviation in the range of ☑5.0%) and PAC were first evaluated during the luteal phase of the menstrual cycle, and elevated PRCs of 248.3 μIU/ml (normal range, 2.8–39.9 μIU/ml) and >500 μIU/ml (normal range, 4.4-46.1 μIU/ml) were evident in both the supine and upright positions, respectively, with normal PAC (15.2 pg/dl in the supine position and elevated PAC of 90.8 pg/dl in the upright position ).
Positive syn skin#
Facial rounding, plethora, development of supraclavicular fat pads, purple skin striae, hirsutism, goiter, proptosis, orthostatic hypotension, and abdominal bruits were not evident upon physical examination.īiochemical assays showed normal liver and renal function, with no hypokalaemia (K 3.8 mmol/L) or metabolic alkalosis (total carbon dioxide 28 mmol/L). The patient’s height was 164 cm, and weight was 52 kg with a normal body mass index of 19.3 kg/m 2. Physical examination showed a blood pressure of 133/96 mmHg in the right arm and 137/97 mmHg in the left arm in the supine position, with a regular pulse of 72 bpm. PRC should be incorporated in the differential diagnosis of secondary hypertension. The clinical features of reninoma may depend on the degree of activation of the renin-angiotensin-aldosterone system (RAAS).
Reninoma can present as mild hypertension without hyperaldosteronism and hypokalaemia. Immunohistochemical staining of the tumour was positive for Renin, CD34, Vimentin, and synaptophysin (Syn) and negative for somatostatin receptor 2 (SSTR2) and chromogranin A (CgA). Based on pathological findings, the patient was diagnosed with reninoma. Enucleation of the tumour led to a rapid remission of hypertension and hyperreninemia. Selective renal vein sampling (SRVS) was performed, and a lateralization of the renin secretion from the left kidney was found. Abdominal contrast-enhanced computed tomography (CT) scanning revealed a solid, low-density, renal cortical mass with delayed enhancement. Interestingly, although the patient had an elevated plasma renin concentration (PRC), her plasma renin activity (PRA) was in the normal range. Endocrine investigation showed hyperreninemia without hyperaldosteronism and hypokalaemia. Case presentationĪ 25-year-old lean Chinese woman with no family history of hypertension was hospitalized for stage 1 hypertension that gradually developed over two years. Typical clinical features include severe hypertension, secondary hyperaldosteronism, hypokalaemia and metabolic alkalosis caused by the overproduction of renin. While in some cases nearly identical to stubborn, pertinacious suggests an annoying or irksome persistence.Reninoma is a rare, benign renal neoplasm. The synonyms obstinate and stubborn are sometimes interchangeable, but obstinate implies usually an unreasonable persistence.Īn obstinate proponent of conspiracy theories When could pertinacious be used to replace stubborn? Pursued the story with dogged perseverance When is it sensible to use mulish instead of stubborn?Īlthough the words mulish and stubborn have much in common, mulish implies a thoroughly unreasonable obstinacy.Ī mulish determination to have his own way In what contexts can obstinate take the place of stubborn? The meanings of dogged and stubborn largely overlap however, dogged suggests an admirable often tenacious and unwavering persistence. While all these words mean "fixed and unyielding in course or purpose," stubborn implies sturdiness in resisting change which may or may not be admirable.Ī person too stubborn to admit error When might dogged be a better fit than stubborn? Some common synonyms of stubborn are dogged, mulish, obstinate, and pertinacious. Frequently Asked Questions About stubborn How is the word stubborn distinct from other similar adjectives?
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