A history of hypertension, high mean arterial pressure, significant renal impairment, modest thrombocytopenia, and lack of severe ADAMTS13 deficiency (activity < 10%) at diagnosis are clues for diagnosing malignant hypertension-induced TMA.[74,75] Several patients have been reported to be in remission with blood pressure control alone without PE.[76–78] In this case, malignant hypertension-induced TMA was considered; however, severe thrombocytopenia was observed and atypical. Here, ADAMTS13 is linked to hyperinsulinemic hypoglycemia, familial, 4.