Introduction: Secondary causes of hypertension exist in 10% of hypertensive subjects. Hypertension refractory to antihypertensive treatment must prompt the physician to screen for secondary causes.
Case presentation: A female 53-year old patient from Libya married and has three children. She works in a factory.
Complaints: Headache in attacks 1 year and 4 months, palpitations 4 months. She was discovered to be severely hypertensive and was given captopril 25 mg bid, with poor control of her ABP. No blurring of vision or diminution of visual acuity. No muscle weakness. No polyuria or polydipsia. No dysuria. Normal bowel habits. Normal sleep.
Past history: No past medical or surgical history.
Family history: No family history of hypertension, diabetes mellitus, dyslipidemia or ischemic heart disease.
Menstrual history: Patient is menopausal since 15 years on no HRT.
Social history and special habits: Nonsmoker. No special habits (no licorice intake, no coffee, tea once per day).
Drug history: Captopril 25 mg bid. No diuretics.
Clinical Examination: Radial pulse = 65 beats/min with 10 dropped beats/min, apical pulse =73 beats/min with 12 dropped beats/min, A.B.P. =170/100 mmHg, BMI =30.20 kg/m2, waist circumference =102.5 cm, hip circumference =99.5 cm, and WHR =1.03.
Heart: Except for the frequent dropped beats and increased A2 over the aortic area, no other abnormalities detected.
Lower limbs: Dorsalis pedis felt bilaterally, soft pitting edema bilaterally ++.
The rest of the clinical examination was unremarkable.
Laboratory and radiological investigations were done.
The various causes of secondary hypertension will be reviewed laying particular stress on the patients laboratory and radiological findings.
Conclusion: Making a diagnosis of a secondary disorder for hypertension is gratifying, because it may lead to significant amelioration or in some instances even cure of the elevated blood pressure like what occurred with the presented case.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology