Abstract

FIGUEIREDO, Vanda Reis; GONCALVES, Ana Catarina  and  VALENTE, Lúcia. Secondary hypertension to an underlying renal neoplasm: a case report. Rev Port Med Geral Fam [online]. 2020, vol.36, n.1, pp.77-80. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i1.12341.

Introduction: Arterial hypertension is a relevant cause of potentially treatable cardiovascular morbi-mortality. The diagnostic workup when facing a de novo case of hypertension implies the identification of cardiovascular risk factors, evaluation of end-organ damage and investigation of hypothetical causes of secondary hypertension. Any sudden and/or severe elevation in blood pressure particularly in a young adult should suggest the possibility of a secondary aetiology for the phenomenon. Case description: 40 years old man, with high blood pressure, overweight and dyslipidaemic, with no other past medical history, reports recent and sudden worsening of his blood pressure values. There were no other complaints and the physical examination was unremarkable. His therapeutics were adjusted accordingly and the diagnostic workup was started - namely routine laboratory study, echocardiography, 12-lead electrocardiogram, and renal ultrasound - to exclude an eventual secondary aetiology. The reports were generally innocent except for the renal ultrasound which revealed a massive formation at the right kidney sinus growing into the renal parenchyma. A CT scan was requested and confirmed the presence of a neoformation, highly likely to be a renal cell carcinoma. The patient was immediately referred to a Urology appointment, via Alert, to the hospital with the shortest predicted waiting time. Nevertheless, the referral was refused on the grounds of “no capacity for timely consultation”, hence the need to reroute the quest to the nearest hospital, which despite the announced longer waiting time, managed to perform a timely accurate laparoscopic nephrectomy. Comment: The present case sustains the absolute need to be familiar with the possibility of a secondary cause for a sudden settlement or worsening of hypertension, particularly in a young patient

Keywords : Arterial hypertension; Renal carcinoma.

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