Abstract
A 61-year-old man presented with malaise, obstipation, sweeting attacks, and weight loos of 13 kg within 3 months. Blood pressure was increased to 220/130 mmHg. Resistant hypertension was diagnosed because blood pressure was uncontrolled in spite of concurrent use of five antihypertensive agents of different classes including a diuretic. Thus, catheter-based radiofrequency ablation of the renal sympathetic nerves was performed. However, the patient's blood pressure did not decrease after the intervention. Computed tomography showed a tumour of abour 7 cm diameter in the left adrenal gland. Serum catecholamines were elevated. Therefore pheochromocytoma was diagnosed. After alpha-adrenergic blockade adrenalectomy was performed. Thereafter blood pressure was normal without antihypertensive therapy. Identification and treatment of causes of secondary hypertension is an essential component in the management of resistant hypertension. Renal denervation should remain an ultimate treatment option only after exclusion of secondary hypertension.
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