The patient, a man, was born in 1947. During the last decade, he was monitored by his
geneal practitioner (GP). A month ago, he moved 1000 kilometers across the country to a
new occupation. The GP is pondering over how to choose and brief a new GP for this special
patient.
The diagnoses of the patient were in rank of risk workaholism, hyperhomocysteinemia,
hyperaldosteronism and hypertonia. It should, however, be emphasized that hypertonia had
not been a clinical problem during the last eight years.
The patient was an ambitious overproducer with great demands on himself in work,
athletics, and hobbies. He started his career as an odd-job man in heavy works. He was
re-educated to technician after his second body breakdown. For family reasons, he then
tarred in his home shire and earned his living as non-authorized college teacher.
About 1985, the patient had to change to a manager job, ”project leader”. He
left the project 1989 and entered electronic engineering, hardware, software and
brainware. After two successful five-year projects, he moved to another part of his
country in order to actualize himselft in care work.
The patient is a sensitive man, stress sensitivity included. His social competence is
excellent. In individual athletics and team athletics, he competed on a good average
level.
His body breakdowns started with a gastrointestinal bleeding 1967; he arrived at the
emergency department with a hemoglobin value of 40 g/L and survived without surgical
procedure after 14 units of blood. Five years later, he broke his back
(”lumbagoischias”) and was re-educated.
At 42, external pressure in his manager job created a malignant blood pressure. Social
reorganisation and hypertonia chemotherapy for a period normalized his blood pressure. The
patient had, however, spontaneously low
serum potassium. Two extensive investigations at an endocrinological special clinic
demonstrated eventually a hyperaldosteronism without evidence of adenoma or hypertrophy of
his adrenal cortex.
The hyperaldosteronism of the patient was treated with spironolactone, 25 mg daily, which
produced a mighty gynecomastia. The hyperhomocysteinemia of the patient was detected 1994.
It had mainly the shape of a pathological methionine load, normalized by peroral therapy
with vitamin B12 1 mg daily, folic acid 10 mg daily, and pyridoxine 80 mg daily.
The patient is an athlete by basic stature. During the last decade, his weight varied
between 80-90 kg, length 173 cm. He smoked in the age of 26-30 years, at most 25
cigarettes a day. He then turned to snuff and remained a snuffer, a ”smoke-free
nicotinist”.
The GP concluded that the basic problem of the patient is existential anxiety, expressed
and sublimed as workaholism. Furthermore, this shy and sensitive man is prone to fall prey
for strong women. His GP asks if the medication of the patient is optimal, and if it is
possible to train one´s adrenal cotex to constant hyperaldosteronism by stress.
The main question of the GP is, finally, how to formulate a referral to a college in the
new city of the patient and encourage this GP to take care of the patient in the future
and support him through possible life crises to come.
Updated september 23, 1999