OnlineMedEd: Surgery: Subspecialty - "Surgical Hypertension" Flashcards
(16 cards)
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
Coarctation is definitively diagnosed with ______________.
CT angiography
