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Aldosterone excess
19%
3/16
Catecholamine-secreting mass
12%
2/16
Cortisol excess
Impaired kidney perfusion
Increased peripheral vascular resistance
25%
4/16
Select Answer to see Preferred Response
This patient has hypertension refractory to multiple medications as well as hypokalemia and a metabolic alkalosis which is concerning for hyperaldosteronism (aldosterone excess). Primary hyperaldosteronism results from excess production of aldosterone. Aldosterone causes increased sodium retention and potassium/hydrogen ion excretion. The sodium retention leads to an increased plasma volume causing difficult to control hypertension. Potassium excretion leads to hypokalemia which can cause muscle cramps and weakness. The most common causes of primary hyperaldosteronism are an aldosterone-producing adrenal adenoma (Conn syndrome) and bilateral adrenal hyperplasia. Treatment involves surgical resection of the mass or potassium-sparing diuretics (spironolactone) in the case of hyperplasia. Incorrect Answers: Answer 2: Catecholamine-secreting mass describes a pheochromocytoma which presents with episodic hypertension, palpitations, diaphoresis, and anxiety. It would not cause sustained hypertension. Treatment generally involves administration of phenoxybenzamine and surgical removal of the mass. Answer 3: Cortisol excess describes Cushing syndrome which presents with hypertension, hyperglycemia, central obesity, moon facies, a buffalo hump, and limb atrophy. It can lead to hypokalemia and a metabolic alkalosis given high levels of cortisol act like a mineralocorticoid; however, this patient has no other symptoms consistent with Cushing syndrome. Answer 4: Impaired kidney perfusion describes renal artery stenosis. Stenosis of the renal artery presents with an abdominal bruit and can be confirmed with an ultrasound with Doppler. This patient's abdominal exam is unremarkable though this is still a plausible diagnosis in case the finding was missed on exam. Treatment involves vascular surgery/stenting to increase renal perfusion and decrease the pathologic activation of the renin-angiotensin-aldosterone system. Answer 5: Increased peripheral vascular resistance can occur in many conditions or can describe idiopathic hypertension. This patient's hypertension is likely secondary to sodium subsequently water retention. Bullet Summary: Hyperaldosteronism presents with hypertension, hypokalemia, and metabolic alkalosis.
4.1
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