sarika
Forum Guru
Topics: 195
Posts: 1,200
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A 15-year-old girl is brought to the physician 3
months after she
had a blood pressure of 150/95 mm Hg at a routine
examination prior to
participation in school sports. She is asymptomatic
and has no history
of serious illness. Twelve months ago, she was
diagnosed with a
urinary tract infection and treated with oral
trimethoprim-sulfamethoxazole.
She currently takes no medications. Subsequent blood
pressure
measurements on three separate occasions since the
last visit have been: 155/94
mm Hg, 145/90 mm Hg, and 150/92 mm Hg. She is at the
50th percentile
for height and 95th percentile for weight. Her blood
pressure today is
150/90 mm Hg confirmed by a second measurement, pulse
is 80/min, and
respirations are 12/min. Examination shows no other
abnormalities. Her
hematocrit is 40%. Urinalysis is within normal limits.
Cardiac and
renal ultrasonography shows no abnormalities. Which
of the following is
the most appropriate next step in management?
A
) Exercise and weight reduction program
B
) Measurement of urine catecholamine levels
C
) Measurement of urine corticosteroid levels
D
) Captopril therapy
E
) Hydrochlorothiazide therapy
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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A.exercise and weight reduction program.
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| aml
Forum Senior
Topics: 5
Posts: 132
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C daily urinary cortisol & corticosteroid excretion, suspect Cushing's syndrome
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| anjushree
Forum Guru
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Posts: 386
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c----cushing
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| sarika
Forum Guru
Topics: 195
Posts: 1,200
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but there is no other sign or symptom suggesting cushing?
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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yes sarika,i got the same doubt but the patient is 15yr old so we must go for the secondary causes of hypertension like cushings even with this solo manifestation.
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| sarika
Forum Guru
Topics: 195
Posts: 1,200
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BUt if thats the case choiceb Measurement of urine catecholamine levels is equally good too? what do u think?
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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yes ofcourse,but there has not been any episodes of hypertension in this caseand its just continuous hypertension,in pheochromocytoma you may see wt loss rather than wt gain,
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| sarika
Forum Guru
Topics: 195
Posts: 1,200
|
good point about wt loss thankyou
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