A rare case of hypothyroid coma developed in a patient with diagnosed primary hypothyroidism, complicated by the development of rhabdomyolysis and prolonged oppression of the respiratory center is presented. The predominance of previous cardiovascular pathology, marked oedema syndrome, and hypercholesterolemia in the clinical picture of the disease initially directed the diagnostics of cardiac pathology, which delayed the diagnosis of hypothyroidism. This publication aims to draw clinicians' attention to hypothyroid coma as a rare complication of hypothyroidism, which in this case was disguised as ischemic heart disease with the development of chronic heart failure.

Objective. To evaluate the morphologу of focal formations of the adrenal glands after adrenalectomy.Design and methods. We analyzed the adrenal glands of 44 patients who underwent the surgery in the Research Institute of Fundamental and Clinical Urinephrology of Saratov in 2004–2016. Renovascular hypertension was the exclusion criterion.Results. The majority of the examined patients (72,7 %) had adrenal hypertension, caused by hormonally active adrenal tumors: pheochromocytoma, corticosteroma and aldosterome. Hormonally inactive tumors were found in 12,5 % patients with adrenal hypertension. Therefore, essential hypertension was diagnosed in these cases. In total 27,3 % patients underwent resection of the incidentalomas, among them 16,7 % were diagnosed as “silent” chromaffin tumors which do not lead to the blood pressure elevation.Conclusions. In the majority of cases (87,5 %), patients who undergo surgery due to adrenal focal formation demonstrate adrenal hypertension related to a hormonally active tumor. Adrenal hypertension is more often diagnosed in middle-aged women, who show higher blood pressure, smaller adrenal glands compared to those who have hormonally inactive adenomas. Based on the morphological study, asymptomatic pheochromocytoma was diagnosed in 16,7 % cases.