In Reply to: Re: Case 0298_01 -- Hypertension in a 40-year-old woman posted by Jeet Sandhu on February 06, 1998 at 17:38:38:
It appears that the hypervascular mass in the left flank, if it is pheo, is not that active. You have indicated that the VMA and metanephrines were mildly elevated and also you did not get the typical hypertensive crisis during the arteriography. Furthermore you have indicated that the BP has been constantly high and pheo is known to produce intermittent hypertensive crisis. So I believe the hypertension is related to the renal artery stenosis and AVF. As for the pathogenesis in the absence of any history of biopsy or trauma, I believe AVF was formed prior to development of significant stenosis because the arterial pressure distal to a significant stenosis would be too low to cause rupture of an aneurysm. So I will treat the AVF first and then the stenosis in the same setting. Surgeons will take care of the vascular mass later with a controlled hypertension.