A 55-year-old man had intermittent paroxysmal arterial hypertension that was considered a consequence of an adrenal tumor. His urine contained high levels of vanillylmandelic acid (VMA). This tumor most likely secreted
A. aldosterone
B. corticosteroids
C. androstenedione
D. adrenaline
E. renin
D
This man has a pheochromocytoma, a tumor of the adrenal medulla that secretes adrenaline and noradrenaline (epinephrine and norepinephrine). These catecholamines are stored in intracytoplasmic granules and can be released all at once, typically causing sudden onset of hypertension (paroxysmal hypertension). Catecholamine is degraded to VMA which is excreted in urine. Aldosterone is released from the outer cortical zone of the adrenal gland (zona glomerulosa) as a result of the action of angiotensin and indirectly because of renal disease marked by elevation of renin. It also can be derived from aldosteronomas, autonomously secreting adrenal cortical tumors. Aldosterone-induced hypertension is slowly evolving and not intermittent. Corticosteroids and androstenedione can be released from some cortical adrenal tumors, but their potency for causing hypertension is low.
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