CASE 3

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CASE 3

• Geography Student with Hypertension

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• C.P. is a 31-year-old student with a four year
  history of hypertension.
• Upon initial evaluation, her K was 2.9 mEq/L, and
  the possibility of primary aldosteronism was
  considered.
• Random serum renin and aldosterone levels were
  normal, however, and the issue was dropped.
• Her hypertension was not controlled during
  treatment with metoprolol, but she did respond
  favorably to treatment with Aldactazide.
• She later discontinued medications, her
  hypertension persisted and K was 3.0 mEq/L.

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• Physical examination, except for a BP of 185/102,
  was unremarkable.
• She did not have a cushingoid habitus.

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Laboratory data Laboratory data

• Na 146 (135-145 mEq/L) Cr 0.7 (lt1.2 mg/dL)
• K 3.0 (3.5-5 mEq/L)
• C1 107 (95-110 mEq/L)
• CO2 27 (22-29 mEq/L)
• EKG nonspecific ST changes, strain
• Your Diagnosis ?
• Most probably a cortical adenoma
• Most probably a cortical carcinoma
• Most probably a pheochromocytoma

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Cortical Adenoma

• CT adrenals -- 2 cm homogeneous mass R adrenal
• The postoperative course was uncomplicated, and
  her BP and serum K on follow-up were normal.