Hipertensão arterial secundária no adulto jovem: um caso clínico
Revista Portuguesa de Clínica Geral
SECONDARY ARTERIAL HYPERTENSION IN A YOUNG ADULT: A CASE REPORT Introduction: Secondary arterial hypertension represents about 5-10% of cases of arterial hypertension. In the presence of hypertension in young adults, secondary causes should be suspected, and the adequate clinical, laboratory and imaging investigations should be performed. In young adults (19-39 years), the most frequent causes of secondary hypertension are thyroid dysfunctions, fibromuscular renal artery dysplasia, and renal
... lasia, and renal parenchymal diseases. We report a case of hypertension in a young woman, whose study revealed an autoimmune hyperthyroidism. Case report: A 19-year-old woman presented to her family physician with palpitations, tachycardia (heart rate: 117bpm), and high blood pressure (mean BP: 154/86mmHg) for one month. Anxiety, initial insomnia, irritability, and polyphagia were also present. Physical examination confirmed the presence of high blood pressure values (mean BP: 150/98mmHg) and tachycardia, as well as palpation of diffuse, painless and symmetrical goiter without apparent nodules. Considering the elevated blood pressure values at two different time points, the diagnosis of arterial hypertension grade I was established, and the patient was medicated with propranolol. Further exams confirmed the diagnosis of autoimmune hyperthyroidism, microcytic and hypochromic anemia, and ultrasound features suggestive of thyroiditis, as well as the presence of diffuse goiter with increased uptake in thyroid scintigraphy, suggestive of Graves' disease. The patient was initially treated with methimazole 5mg bid, and referred to endocrinology consultation. The treatment resulted in improved symptomatology, tensional stabilization, and normalization of the thyroid function. Discussion: This case aims to illustrate the diagnostic and therapeutic approach of hypertension in young adults, in a primary care setting. Hyperthyroidism is a common cause of isolated systolic hypertension, and its timely diagnosis and treatment can prevent the occurrence of complications, and influence prognosis. To this end, it is essential to achieve an adequate collaboration between primary and secondary care.