DrVirgo
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answer?
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| cirus
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Autonomous prod of aldosterone
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| DrVirgo
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I guessed A also. so I agree
But:
What is causing her HTN?
Why is Na normal if answer is autonomous production of aldosterone?
Doesn't aldosterone cause Na reab. and K. secreation?
What is art. nicking?
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| robin082006
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E
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| DrVirgo
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Can you please explain WHY you think its either A or E or whatever?
Thanks.
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| robin082006
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this patient has sign of hyperaldosteronism
So A or E may be the answer.
Most cases of hypertension, difficult to treat, in young persons are due to renal stenonis---> decrease blood flow to juxta-->increases renin production and makes juxta hypertrophy)--> increase aldosterone.
the increase in aldosterone is secondary, not primary or autonomous. Autonomous production seen in adrenal tumor, which is less common.
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| dr in trouble
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I will go with A as this is primary hyperaldosteronism due to not having edema.
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| khorshid
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Robin is right, E could be correct, for following reasons:
!. in primary we have hypernatremia
2. in secondaries we have edema EXCEPT for Barter syn!
3. In Barter syn we lose Na and cl. (this pt's cl is low)
The only point which is not quite right, is that we have diastolic HTN in primary 
But still I'll go with Barter syn (which is exactly juxtaglomerular hyperplasia with severe hypokalemic alkalosis)
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| dr in trouble
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I think they cleraly mentioned in the qs about no edema and abdominal bruit to rule out renal stenosis.
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| khorshid
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Well as I said "no edema" doesn't rule out Barter at all. The same for renal stenosis.
But how do you explain lack of hypernatremia and low chloride levels?
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| hanialkhadher
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NOTE: IN BARTTER NO HYERTENSION this is one,
2nd Cl is decreased in hyperaldosteronism
3rd ADRENAL ADENOMA IS THE MOST COMMON COUSE OF HYPERALDOSTERONISM
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| hanwin
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I will go for A .
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| Ivonne
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I picked A too but i am not confident...
Why not E?
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| drshvetasm
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the sodium is not high coz in long standin disorders like these escape occurs cozrelease of ANP causes sodium loss...
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