SECONDARY HYPERTENSION, LONG WAY

Objective: Knowledge of the impact of the negative effects of excess Aldosterone makes the study of Hyperaldosteronism as a cause of secondary hypertension even more relevant. A pathology very often underdiagnosed. One of the many reasons for not reaching the diagnosis, is not persevering and not reassessing. Our patient took almost 20 years to receive a definitve diagnosis and treatment. It should be taken into account in those cases in which blood pressure levels remain high despite the use of multiple drugs. For a correct diagnosis, a complete clinical history is essential, as well as a study by means of complementary tests. Design and method: The patient is a 46-year-old man whose pathological history includes arterial hypertension diagnosed at the age of 25 years with a no findings for secondary hypertension. His blood pressure figures were still poorly controlled an he soon needed three drugs to control them. Folow-up notes hightlighted the progressive increase in heart rate and glycaemia and the progressive decrease of kalaemia. At 45 years of age, the patient was already diagnosed with resistant arterial hypertension and diabetes mellitus 2 and consulted us for hypokalaemia that was difficult to control with oral supplementation. Given the suspicion of hyperaldosteronism, screening tests were performed and an imaging study with a Computed Tomography scan of the adrenal gland showed a lesion compatible with adenoma measuring 10 mm in the right adrenal gland and another 13 mm in the left adrenal gland. Given the results, a provocation test was positive and the case classified as bilateral primary hyperaldosteronism. Adrenal catheterization revealed left lateralization and left adrenalectomy was performed. Results: After surgery, the patient has good control of his blood pressure and blood glucose levels, allowing the progressive reduction of antihypertensive and antidiabetic drugs. Conclusions: Actively look for secondary hypertension in young patients, reassess the results and repeat, especially if the outcome is unfavourable. In our case, despite the great improvement, it is likely that the damage will not allow the withdrawal of antihypertensive treatment due to the delay in diagnosis of many years