patho 9 - aimhigh

[ArchivalUser]

A 45-year-old man presents to a physician with flank pain and hypertension. Serum chemistries
demonstrate slightly increased blood urea nitrogen and creatinine. Hematuria is noted on
urinalysis. Ultrasound studies demonstrate markedly enlarged kidneys with irregular margins and
many fluid-filled spaces of varying sizes. Excessive secretion of which of the following
hormones would most likely account for the patient's hypertension?
A. ACTH
B. Cortisol
C. Parathormone
D. Renin
E. Thyroxine

[ArchivalUser]

D.

[ArchivalUser]

d.......

[ArchivalUser]

APKD agree D

[ArchivalUser]

oups i'm too lateeeee...agree D...

[ArchivalUser]

sorry to reply late guys,, The correct answer is D. The disease is adult polycystic kidney disease, which is an autosomal
dominant condition that typically manifests in middle age. While the kidneys appear very badly
deformed, they function surprisingly well because the cystic spaces actually only affect 10% or
less of the nephrons. Pressure exerted by the cysts can somewhat compromise blood flow to some
glomeruli, which is probably why hypertension, as a consequence of renin secretion, is such a
problem for these patients.
ACTH (choice A) can stimulate cortisol (choice B) secretion, and the cortisol (in high amounts)
can have enough mineralocorticoid activity to cause hypertension. However, this would be more
likely with a pituitary tumor, adrenal tumor, or with exogenous corticosteroid use.
Parathormone (choice C) regulates calcium metabolism and does not usually affect blood
pressure.
Thyroxine excess (choice E) can cause hypertension as a consequence of its effects on the heart
and vasculature; this might be seen in the setting of hyperthyroidism due to thyroid disease.