[A 58-year-old hypertensive patient with primary hyperaldosteronism and renal artery stenosis].

BACKGROUND: Secondary hypertension can rarely be caused by different disorders as shown in the present case with simultaneous occurrence of two possible causes. CASE REPORT: Magnetic resonance imaging findings of a 58-year-old patient showed an eccentric left renal artery stenosis of 60-70% and an inhomogeneous tumor of the left adrenal gland. After percutaneous transluminal angioplasty, elevated plasma aldosterone concentrations persisted. Adrenal vein sampling in the authors' hospital confirmed a primary hyperaldosteronism due to unilateral adenoma. Subsequently, unilateral laparoscopic adrenalectomy was performed.
CONCLUSION: Atherosclerotic renal artery stenosis stimulates the renin-angiotensin system and thereby causes secondary hypertension. Furthermore, adrenal disorders that lead to abnormal aldosterone secretion, i.e., primary hyperaldosteronism, often result in secondary hypertension. Though the simultaneous occurrence of two potential causes of secondary hypertension is rare, it has to be considered for differential diagnosis and therapy. The presumed pathophysiological relevance should guide the order of therapeutic measures.