03-23-2007, 06:47 AM
A 15-year-old boy is evaluated for hypertension after his blood pressure was elevated on multiple occasions. He also reports generalized weakness and fatigue. His family history is positive for hypertension. Physical examination reveals a blood pressure of 185/110 mm Hg and a pulse of 91 bpm. Heart, lung, abdominal, and extremity examinations are unremarkable. The patient has no thyromegaly or abdominal/flank bruits. Results of a laboratory evaluation are as follows: serum sodium, 140 mEq/L; serum potassium, 2.1 mEq/L; serum chloride, 98 mEq/L; serum bicarbonate, 34 mEq/L; thyrotropin, 2.5 µU/mL; free thyroxine, 1.3 ng/dL; plasma renin activity (supine), 0.15 ng/mL/hour; plasma renin activity (upright), 0.2 ng/mL/hour; plasma aldosterone (supine), 2.1 ng/dL; plasma aldosterone (upright), 2.4 ng/dL; urine aldosterone, 5 µg/24 hours; urine potassium, 54 mEq/L. Which of the following is the most likely etiology of severe hypokalemia and hypertension in this patient?
1..Adrenal adenoma
2..Fibromuscular dysplasia of the renal arteries
3..Glucocorticoid remediable aldosteronism
4..Liddle™s syndrome
1..Adrenal adenoma
2..Fibromuscular dysplasia of the renal arteries
3..Glucocorticoid remediable aldosteronism
4..Liddle™s syndrome