10-20-2010, 01:37 PM
A 28-year-old female has hypertension that is difficult to control. She was diagnosed at age 26. Since that time she has been on increasing amounts of medication. Her current regimen consists of labetalol 1000 mg bid, lisinopril 40 mg qd, clonidine 0.1 mg bid, and amlodipine 5 mg qd. On physical examination she appears to be without distress. Blood pressure is 168/100, and heart rate is 84 beats per minute. Cardiac examination is unremarkable, without rubs, gallops, or murmurs. She has good peripheral pulses and has no edema. Her physical appearance does not reveal any hirsutism, fat maldistribution, or abnormalities of genitalia. Laboratory studies reveal a potassium of 2.8 mEq/dL and a serum bicarbonate of 32 mEq/dL. Fasting blood glucose is 114 mg/dL. Her diagnosis is Conn's syndrome. What is the best way to diagnose this disease?
A. Renal vein renin levels
B. 24-h urine collection for metanephrines
C. Magnetic resonance imaging of the renal arteries
D. 24-h urine collection for cortisol
E. Plasma aldosterone/renin ratio
A. Renal vein renin levels
B. 24-h urine collection for metanephrines
C. Magnetic resonance imaging of the renal arteries
D. 24-h urine collection for cortisol
E. Plasma aldosterone/renin ratio