Question

QUESTION 3 A 35 yr old man is seen by his physician for headache, fatigue, muscle weakness, feeling tired all the time. He is diagnosed with hypertension and mild depression. His physician prescribes Propanolol, a beta blocker that should reduce production of epinephrine and therefore control his blood pressure. He is also asked to increase his exercise levels to combat depression. On next month's follow-up visit, patient's blood pressure was noted to be high even though patient reports complying with all medicine instructions. His physician orders blood tests and the results are shown below: Blood volume status: high Potassium: 2.5 mEq/L (3.5-5 mEq/L) pH: 7.6 Plasma aldosterone concentration: 22ng/dL (< 15ng/dL) Plasma renin activity: 0.6 ng/mL per hour (>1 ng/mL/h) a. What is the likely diagnosis? b. Explain the possible biological cause/s behind the diagnosis. c. How can the diagnosis be confirmed with further biochemical testing? Explain the expected results. d. How can the biological cause behind the diagnosis be identified? e. Explain the connection between the diagnosis and the patient's blood pressure, potassium and pH changes.

Answer 1

1. Primary aldosteronism or conn's syndrome :It is increased production of aldosterone from adrenal gland resulting low renin level characterized by hypertension, hypokalemia and high blood volume.
2. Idiopathic adrenal hyoerplasia, familial hyperaldosteronism, Adrenal carcinoma, Aldosterone secreting adenoma are responsible for primary aldosteronism.
3. Fludrocortidone suppression :Fkudicortisone acetate 0.1mg orally q6h, sodium chloride mMq6h and potassium supplementation 4days. The result PAC >5ng/dl, PRA<1ng/dl in morning after 4days.

• IV saline load :2L of 0.9%sodium chloride infusion over 4hours. PAC after infusion is >5ng/dl.
• Oral saline load :300mM sodium for3days with potassium supplement. Result show that urinary aldosteron after 3days >12ng/24hours and urinary sodium >200mM.