recent CCS- young age pt Htn due to adrenal hyperp - jayhind

[ArchivalUser]

.....

[ArchivalUser]

PE

CBC
BMP
ECG
UA
EKG
CXR
PULSE OXY
VITALS
BP MONITOR
CHECK BP MONITOR

sent home followup in 1 wk

interval h/o
PE
vitals
renin
aldosterone
bmp
ct abd
24 hr urine cortisol
24 hr VMA

follow up with results

ACEI
low salt diet

5min screen
counsel
age related screening

[ArchivalUser]

PE
CBC
BMP
serum cortisole
VMA/metanephrin
EKG
CHEST X-TAY
HOME BP MONITOR

5 day appointment

24 hr-serum cortisole
dexa suppression test
renin
aldosterone
ACTH
17-hydroxyprogestron
11-hydroxylase
urine -17alpha ketosteroids
abdominal CT

ENDOCRINOLIGY CONSULTATION

TX
COETICOSTERON
low salt diet
FOLLOW UP

[ArchivalUser]

sorry sorry typo

11-deoxycortisole

tx
HYDROCORTISONE

[ArchivalUser]

pe

cbc

bmp

urinary metanephrines

if hypokalemia and hypernatremia do renin: angiotensin ratio

if reduced- do ct abdomen

conn's syndrome- admit, correct hypokalemia, contrl bp with spironolactone for 1-2 weeks , then laparoscopic adrenalectomy.

phaeochromocytoma- control bp with phentolamine, then laparoscopic adrenalectomy.

[ArchivalUser]

any idea how this case presented? jayhind??? anyone???

[ArchivalUser]

25 yr old pt 160/90 with previous 2 high BP readings...

[ArchivalUser]

full physical

Pulse oxy
CBC
BMP
EKG
CXR
lipid profile
LFTs
UA
diet
exercise

send home call after 1 week
results shows-- low K+

interval history
BP check
renin
aldo
dexa supression test
urin VMA

renin/ald ratio is >20

start spironolactone
CT abd
educate


CT shows adrenal mass

surgery consult
adrenelectomy

[ArchivalUser]

hey jay..how ar eyou holding up? you will do more than fine...good luck
thanks for responding to my q...

as i was looking at "goodnew's " hard work on this ccs and got all confused...goodnews's workup is more for Congenital Adrenal Hyperplasia....right? that case shoul d have some mention of ambigous genitalia..i think! and should be a child....anyway.

but this case is basically about Primary hyperaldosteronisim or CONN's syndorme..
and our differential is pheo, Conn's and Cushing's here.

[ArchivalUser]

Exactly..!!!!!