A 40-year-old man with resistant hypertension, no Cushing or sleep apnoea symptoms. BP 150/95, LVH on ECG. Na 147, K 3.2, aldosterone 915 pmol/L (high), renin <0.6 (suppressed). What is the next step?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: B. CT adrenal without contrast
Resistant hypertension + spontaneous hypokalaemia + markedly high aldosterone (915 pmol/L ≈ 33 ng/dL) with suppressed renin = primary hyperaldosteronism. With this combination (spontaneous hypokalaemia, undetectable renin, aldosterone >20 ng/dL) a confirmatory suppression test is considered unnecessary, so the next step is adrenal CT to look for adenoma vs bilateral hyperplasia. Renal artery Doppler is for secondary (high-renin) hyperaldosteronism; dexamethasone suppression and polysomnography were excluded clinically (no Cushing or sleep-apnoea features).
ليش كل خيار صح أو غلط
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A
ليش غلط
Renovascular disease causes secondary hyperaldosteronism through excessive renin stimulation; his renin is suppressed, so the renal arteries are not the next target.
✓ Adrenal summary.pdf · p. 4 -
B
ليش صح
Once primary hyperaldosteronism is biochemically established, adrenal CT is the initial test to find its cause, separating adenoma from bilateral hyperplasia.
✓ Adrenal disorders (2).pdf · p. 13 -
C
ليش غلط
The dexamethasone suppression test screens for Cushing syndrome; he has no cushingoid features and his aldosterone and renin results already point elsewhere.
✓ Adrenal disorders (2).pdf · p. 9
- المصدر
- Adrenal disorders (2).pdf · p. 12
Adrenal disorders (2).pdf · p. 13 - المحاضرة
- Primary Hyperaldosteronism · Endocrinology · Module B
- ظهر في
- MED41 ♀ EOM B