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Title:Trojni nadledvični vzrok arterijske hipertenzije – ali pač?
Authors:ID Lapajne, Tina (Author)
ID Kocjan, Tomaž (Author)
Files:URL URL - Source URL, visit https://vestnik.szd.si/index.php/ZdravVest/article/view/3660/4720
 
Language:Slovenian
Typology:1.04 - Professional Article
Organization:Logo ZSZD - The Slovenian Medical Association
Abstract:Hipertenzijo ima do 40 % odrasle populacije in je pomemben dejavnik tveganja za srčno-žilne bolezni. Pri približno 15 % gre za sekundarno hipertenzijo, katere vzrok je lahko ozdravljiv, tako da je hipertenzija lažje vodljiva ali celo ozdravljiva. Med vzroki sekundarne hipertenzije je najpogostejši primarni aldosteronizem. Predstavljava primer 68-letnega bolnika z dolgoletno neurejeno hipertenzijo, pri katerem so bili s CT trebušnih organov odkriti incidentalomi nadledvičnih žlez. Endokrinološko diagnosticiranje je potrdilo presežek aldosterona, blago avtonomno izločanje kortizola in povišan norme-tanefrin v urinu. Odločili so se za levostransko adrenalektomijo. Patohistološki izvid je pokazal aldosteron-producirajoči adenom. Dva meseca po adrenalektomiji je bil bolnik biokemično ozdravljen, kar pomeni, da primarnega aldosteronizma nima več. Devet mesecev po operaciji smo dosegli dobro urejen arterijski krvni tlak ob uporabi manj antihipertenzivnih zdravil. Sočasno blago avtonomno izločanje kortizola (MACS) je prisotno pri eni tretjini oseb s primarnim aldosteroniz-mom in je dodaten dejavnik tveganja za srčno-žilne bolezni. Pri našem bolniku je bil z adrenalektomijo ozdravljen tudi MACS. Vztrajal je le še povišan normetanefrin v 24-urnem vzorcu urina, kar pa je v našem primeru najverjetneje posledica obstruktivne spalne apneje. S prikazanim kliničnim primerom želiva opozoriti na pomen diagnosticiranja sekundarne ar-terijske hipertenzije, saj lahko etiološko zdravljenje izboljša ali celo ozdravi zvišan krvni tlak ter zmanjša tveganje za okvaro tarčnih organov. Poudarjava tudi pomen racionalnega endokrinološkega diagnosticiranja, vključno s kritično interpreta-cijo hormonskih izvidov.
Keywords:nadledvična žleza, sekundarna arterijska hipertenzija, incidentalom, feokromocitom, primarni aldosteronizem
Publication status:Published
Publication version:Version of Record
Year of publishing:2026
Number of pages:str. 146-152
Numbering:Letn. 95, št. 5/6
PID:20.500.12556/DiRROS-32353 New window
UDC:616.12-008.331.1:616.45
ISSN on article:1318-0347
DOI:10.6016/ZdravVestn.3660 New window
COBISS.SI-ID:288011011 New window
Note:Besedilo v slov.
Pub. date in DiRROS:08.09.2026
Views:37
Downloads:10
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Record is a part of a journal

Title:Zdravniški vestnik : glasilo Slovenskega zdravniškega društva
Publisher:Slovensko zdravniško društvo
ISSN:1318-0347
COBISS.SI-ID:32893696 New window

Licences

License:CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
Link:http://creativecommons.org/licenses/by-nc/4.0/
Description:A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

Language:English
Title:Triple adrenal cause of arterial hypertension – or not?
Abstract:Hypertension affects up to 40% of the adult population and is a major risk factor for cardiovascular disease. About 15% of hypertension cases are secondary and may have a curable underlying cause, leading to improved blood pressure control or even complete resolution of hypertension. Among the causes of secondary hypertension, primary aldosteronism is the most common. We present a case of a 68-year-old man with long-standing poorly managed hypertension and ad-renal incidentalomas on an abdominal CT scan. Endocrine evaluation confirmed aldosterone excess, mild autonomous cortisol secretion (MACS), and elevated urinary normetanephrine. Therefore, he was referred to a urologist for laparo-scopic left adrenalectomy. Histopathological examination revealed an aldosterone-producing adenoma. After adrenalec-tomy, the patient’s primary aldosteronism was cured. His blood pressure was well-controlled with fewer antihypertensive medications. Concomitant MACS, which is present in one-third of patients with primary aldosteronism and represents an additional cardiovascular risk factor, was also resolved following adrenalectomy. Elevated normetanephrine in a 24-hour urine sample persisted after surgery, most probably due to obstructive sleep apnea. With this clinical case, we aim to high-light the importance of diagnosing secondary hypertension, as etiological treatment may improve or even cure high blood pressure and reduce the risk of target organ damage. We also emphasize the importance of rational endocrine diagnostics, including critical interpretation of hormonal test results.


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