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USMLE Step 2 CK Classic Clues Classic clues seen in clinical case scenarios in USMLE Step 2 CK questions.


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  #1  
Old 03-20-2010
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Thyroid Hypertension + Adrenal Mass

If you face a case where the patient is presented with elevated blood pressure and a mass in the adrenal seen in CT scan or MRI then you have two options:
  1. Pheochromocytoma
  2. Primary hyperaldosteronism
The differentiation is relatively easy:
In Pheochromocytoma you have elevated catecholamines with its consequent increased urinary VMA and cortisol and the crises of tachycardia, sweating, irritability ...etc
In Conn's syndrome you have the effects of high aldosterone such as hypokalemia and alkalosis.

While surgical treatment is similar for both of them with resection of the tumor or adrenalectomy, medical treatment is certainly different.
In pheo you give alpha and beta blockers while in conn you give aldosterone antagonists such as sprinolactone or amiloride.

See also this related thread
Differentiating Aldosterone Adenoma from Idiopathic Hyperaldosteronism

Last edited by rasheed; 05-06-2010 at 09:53 PM. Reason: Related thread linking
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  #2  
Old 04-23-2010
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Thanks for the great explanation.. I enjoyed it
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Old 04-23-2010
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Simple, comprehensible, to-the-point... Well done!
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Old 07-26-2010
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I agree hello

thanks for your useful post,with your permission adding that we can prescribe in pheochromocytoma drugs of:

alpha blocker such as phentolamine,
also can give alpha and beta blocker such as labetalol,
but never can give exclusively beta blocker because of elevating alpha adrenergic effects
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Old 12-04-2011
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to add Aldosterone antagonist: Spironolactone and eplerenone can be given but eplerenone is preferred as chances of androgenic side effects are less with it
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Old 06-17-2016
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Default little more

Quote:
Originally Posted by rasheed View Post
If you face a case where the patient is presented with elevated blood pressure and a mass in the adrenal seen in CT scan or MRI then you have two options:
  1. Pheochromocytoma
  2. Primary hyperaldosteronism
The differentiation is relatively easy:
In Pheochromocytoma you have elevated catecholamines with its consequent increased urinary VMA and cortisol and the crises of tachycardia, sweating, irritability ...etc
In Conn's syndrome you have the effects of high aldosterone such as hypokalemia and alkalosis.

While surgical treatment is similar for both of them with resection of the tumor or adrenalectomy, medical treatment is certainly different.
In pheo you give alpha and beta blockers while in conn you give aldosterone antagonists such as sprinolactone or amiloride.

See also this related thread
Differentiating Aldosterone Adenoma from Idiopathic Hyperaldosteronism
let me add more tips:
-pheochromocytoma-episodic htn...but hyperald is chronic one
-ttt of pheochrom, emphasize on give FIRST alpha block before beta block...i feel more convenient than saying give both..i know u meant same...
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Old 07-09-2016
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Default thankss

thanks...........
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