A 17-year-old adolescent was referred to the metabolic ambulance because of serious combined hyperlipidae- mia with extreme parameters of lipid metabolism with a total cholesterol of 14.64 - 27.6 mmol/l, triglycerides 16.42 - 51.15 mmol/l, beta-lipoproteins 22.5 g/l, lipidaemia 37 g/l and highly chylous serum. The boy was obese - 119 kg and hypertensive (150/100 mm). Genealogical and laboratory examination did not suggest a primary cause of hyperlipidaemia nor any other disease which could have an impact on the lipid metabolism. Laboratory examina- tion in the family revealed normal cholesterol and triglyceride values in the mother and sister, the father had slightly elevated triglycerides. By dietary and lifestyle measures and very good cooperation it proved possible after 7 months to reduce the weight by 16 kg, achieve normal blood pressure readings, and to normalize eventually the parameters of lipid metabolism. The authors emphasize the importance of lifestyle changes before pharmacological treatment is started, even in patients with serious disorders of the lipid metabolism, in particular in children and adolescents.

        Key words: hyperlipidaemia, therapy