OnlineMedEd: Surgery: Subspecialty - "Surgical Hypertension" Flashcards
What two factors, when seen together, highly suggest hyperaldosteronism?
HTN and hypokalemia
When you suspect hyperaldosteronism (HTN and low K), the first test you should do is ______________.
a aldosterone:renin ratio
This will tell you if it is due to high renin (low-volume or low-volume-mimicking states) or independent of renin.
If the aldosterone:renin ratio is greater than _____________, you should follow-up with a salt-suppresion test: give IV NaCl and see if the elevated aldosterone suppresses.
20
What two tests do you need to do prior to removing an adenoma?
- CT/MRI to look for the suspected adenoma
* Adrenal vein sampling to verify that the localized adenoma is the hyperfunctioning one
What does it mean if a person has HTN, low K, and an aldosterone:renin ratio less than 10?
Renal artery stenosis
How do you diagnose renal artery stenosis?
- HTN and low K
- Aldosterone:renin ratio less than 10
- Renal artery Doppler
- Angiogram
Renal artery stenosis should be managed how?
- Young women with fibromuscular dysplasia: stent
* Older men: anti-aldosterone/angiotensin II drugs
Pheochromocytoma presents with the five P’s: __________________.
- Paroxysms of
- Pressure elevations
- Pain in the head
- Palpitations and
- Perspiration
Diagnose pheochromocytoma with 24-hour urinary metanephrines and __________.
VMA
In order to definitively diagnose pheochromocytoma, you need to _____________.
do urinary metanephrines/VMA, CT/MRI to lateralize it, and adrenal vein sampling to conclusively lateralize it
Why do you need to have a high index of suspicion for Cushing’s?
The symptoms are common and nonspecific: HTN, acne, and diabetes. Look for the other, more specific signs: buffalo hump, striae, moon facies.
How do you diagnose Cushing’s?
1) Look for the signs: HTN, DM, acne, striae
2) Do a midnight salivary cortisol or 24-hour urinary cortisol
3) Dexamethasone suppression of cortisol test
4) ACTH levels: if low, then primary adrenal tumor; if high, then Cushing’s disease or ectopic ACTH-secreting tumor
Once ACTH levels are discovered to be low and adrenal adenoma is suspected as a cause of Cushing’s syndrome, you need to do _______________.
a CT/MRI and adrenal vein sampling to definitively lateralize it
Once ACTH levels are discovered to be high, do the _______________ test.
high-dose suppression test
Pituitary tumors (Cushing’s disease) will suppress, while ectopic tumors will not.
What is an x-ray sign of coarctation?
Rib notching due to collaterals
