Aashi
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A 36-year-old man is admitted to the hospital for severe hypertension. He has had high blood pressure for the past 3 years that has been very difficult to control. There is no history of hypertension in his family and he has no other medical problems. His current medications include hydralazine, amlodipine, and atenolol. His blood pressure log-book that he keeps at home shows that his daily pressures have been on average 180/90 mm Hg. Today he was admitted for a blood pressure of 220/120 mm Hg with pulse of 82/min. On physical examination, he is appropriately anxious but in no distress. He fundi are clear with no evidence of papilledema. His heart exam is benign. An electrocardiogram shows left ventricular hypertrophy .An ECG shows left ventricular hypertrophy at 80 beats per minute with no strain pattern.
Laboratory studies show:
Sodium 151 mEq/L
Potassium 2.6 mEq/L
Bicarbonate 28 mEq/L
BUN 10 mg/dL
Creatinine 0.8 mg/dL
The most appropriate diagnostic test at this time is
A. an abdominal CT scan
B. a head CT scan
C. a renal scan
D. a renal vein renin level
E. urine catecholamine and VMA levels
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| robin082006
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A this patient may has COnn syndrome(hyperaldosteronism)
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| star1
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E. urine catecholamine and VMA levels
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| robin082006
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Star, we choose E if pheochromocytoma is suspected.
Here we suspect hyperaldosteronism (hypertension, hypernatremia, hypokalemia). So I think A is the best choice.
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| aml
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E
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| Aashi
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Hi Star1, U are a person who gives a good thought to the q,before attempting it,some1 who has good 'brains'...what made u think for pheochromocytoma here...just curious...thatz all..
Thanks
GL 
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| star1
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Robbin you are Correct,
guys I am sorry, Actually i was going to sleep and just did not read the Q carefully,
This is CONN syndeome having Hypernatremia, Hypokalemia, metabolic Alkalosis ( high HCO3)
CONN syndrome is a primary Hyperaldosteronism
Now Q how can we differentiate between primary verses sec, Hyperaldosteronism?
In primary there is Hypernatremia and decrease level of renin, while in sec. there is no Hypernatremia and increase renini level...........................
Now I need one clarification ..................
what happened to pulse rate in Hypertension?
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| Aashi
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Ans is CT scan of the abdomen-->CONNS $
Pulse rate can be normal-->except in pheochromocytoma( where we have episodic HTN with S/S of sympathetic hyperactivity) so If the case was of a pheochromocytoma ,along with this massive pressure elevation,one shld be tachycardic and diaphoretic etc.....
Regarding secondary hyperaldo--->yes its renin DEPENDENT hyperaldo and primary is renin INDEPENDENT..hypernatremia per se is not seen with secondary hyperaldo,,though we do have NA and H20 retention,H2O is retained more than NA,and so we dont NA levels of the given range as above in secon hyper aldo..we dont get HTN(diastolic) with secon hyper aldo-->except renal artery stenosis( p/ex shows abd bruits,HTN resistant to therapy,dearrangements in renal lab parameters-->next step is captopril scan /u/s and confirmed by MRA-->here history ,P/EX and lab doesnt support any evidence for renal artery stenosis-->so no need of renal scan here...regarding renal vein renin levels-->this is a cumbersome,invasive test,not done acutely)
So YOUNG PT +HTN + HYPOKALEMIA +HYPERNATREMIA with negative P/E( for secondary aldo)--->think of primary hyperaldo until proven otherwise....
GL
Edited by Aashi on 12/19/06 - 02:15 PM
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