Surgical Hypertension

Question 1

Primary hyperaldosteronism

Answer 1

Adenoma or hyperplasia of adrenal
Hypokalemia in hypertensive pt, usually female
Modest hypernatremia & metabolic alkalosis
Aldosterone levels are high
Renin levels are low
Appropriate response to postural changes suggest hyperplasia- Tx medically
Lack of response to posture changes dx adenoma
Adrenal CT localizes- surgical removal

Question 2

Pheochromocytoma

Answer 2

Seen in thin, hyperactive women
Bouts of pounding HA, perspiration, palpitations, & palor w/ extremely high BP at that time
Dx w/ 24h urine VMA, metanephrine, or catecholamines
Follow w/ CT or radionuclide studies looking for extraadrenal sites
Tumor usually large
Surgery req careful pharm prep w/ alpha blockers

Question 3

Coarctation of the Aorta

Answer 3

Young; HTN in arms but normal in lower extremities
CXR shows scalloping of ribs- erosion from large collateral interconstals
Spiral CT w/ IV dye dx
Surgical correction curative

Question 4

Renovascular HTN

Answer 4

Young women w/ fibromuscular dysplasia or old men w/ arteriosclerotic occlusive disease
HTN resistent to usual meds
Faint bruit over flank or upper abdomen
Duplex scanning of renal vessels & CT angio
Young women get balloon dilation or stenting
Old men tx is controversial