Thread by @aishaikh

An interesting case of new onset HTN and hypokalemia in a patient with leiomyosarcoma

Serum K 2.9
BP 150/90
No accompanying acidosis or alkalosis👇🏽
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#onconephrology

Step 1: Is the hypokalemia due to renal K losses or extra-renal K losses?

24 hour urine K was 46 mEq/L so renal K losses were contributing to hypokalemia

Serum magnesium was normal

Patient was not on diuretics👇🏽
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In the setting of new onset hypokalemia and new onset HTN, there was high suspicion for mineralocorticoid excess or AME

So, plasma renin activity (PRA) and plasma aldosterone were checked

‼️Both PRA and aldosterone were elevated👇🏽
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Common causes of high PRA and high aldosterone in the setting of HTN include:
Renal artery stenosis
Renal artery dissection
Renin producing tumors
Malignant HTN

Renal Artery Doppler did not show evidence of renal artery stenosis
4/

Renin producing tumor was considered to be the likely cause of high PRA/high aldosterone

The source of high renin was likely the underlying leiomyosarcoma as imaging showed progression of disease
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Patient was initiated in ACE inhibitors and within 48 hours the serum potassium and BP normalized 👇🏽
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Cases of renin producing leiomyosarcoma are rare but have been described 👇🏽

pubmed.ncbi.nlm.nih.gov/8023829/

Definite treatment for the high renin is treatment of the underlying cancer
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