From the Guidelines
A suprarenal mass can indeed cause hyperreninemia, particularly in cases of primary aldosteronism, as suggested by the recent guidelines 1. When considering the potential effects of a suprarenal mass on renin levels, it's crucial to understand the different types of adrenal tumors and their hormonal secretions. According to the guidelines, patients with adrenal incidentalomas and hypertension and/or hypokalemia should be screened for primary aldosteronism with an aldosterone-to-renin ratio 1.
Key Points to Consider:
- Hyperreninemia can be a consequence of certain suprarenal masses, especially those secreting renin or aldosterone.
- The diagnosis involves measuring plasma renin activity and aldosterone levels, along with imaging studies to locate the mass.
- Treatment typically requires surgical removal of the tumor, with possible temporary medical management using antihypertensives.
- The guidelines recommend a multidisciplinary review for cases where imaging is not consistent with a benign lesion or when there's evidence of hormone hypersecretion 1.
Clinical Implications:
The presence of a suprarenal mass necessitates a thorough work-up to identify any potential hormonal imbalances, including hyperreninemia. The most critical step is to screen for autonomous cortisol secretion and primary aldosteronism, as these conditions can significantly impact patient outcomes 1. By prioritizing the screening and appropriate management of these conditions, clinicians can effectively reduce morbidity, mortality, and improve the quality of life for patients with suprarenal masses.
From the Research
Suprarenal Mass and Hyperreninemia
- A suprarenal mass can cause hyperreninemia, as evidenced by cases of renin-secreting tumors 2, 3, 4, 5, 6.
- These tumors can lead to the overproduction of renin, resulting in hyperactivation of the renin-angiotensin-aldosterone system and subsequent hypertension and hypokalemia 2, 3, 6.
- The clinical features of reninoma, a type of renin-secreting tumor, may vary and can include mild hypertension without hyperaldosteronism and hypokalemia 4.
- Diagnosis of renin-secreting tumors can be prompted by screening for primary aldosteronism, and imaging techniques such as abdominal contrast-enhanced computed tomography (CT) scanning and selective renal vein sampling (SRVS) can be used to localize the tumor 4.
- Surgical removal of the tumor can lead to a rapid remission of hypertension and hyperreninemia 3, 4, 5, 6.
Types of Renin-Secreting Tumors
- Reninomas are functional tumors of afferent arteriolar juxtaglomerular cells that secrete the enzyme renin 2.
- Other types of renin-secreting tumors, such as renal hemangiopericytoma, have also been reported 3.
- Adrenal tumors can also produce renin, leading to hypertension and hyperreninemia 5.
Diagnosis and Treatment
- Plasma renin activity (PRA) and plasma renin concentration (PRC) can be used to diagnose hyperreninemia 2, 4.
- Medical management of renin-secreting tumors can include aldosterone receptor blockade, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers, but surgical curative resection is often ideal 2.
- The use of calcium-channel blockers and ACE inhibitors can also be effective in managing hypertension associated with renin-secreting tumors 3, 5.