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Old 10-17-2011
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Question Electrolytes in adrenocortical adenoma

A previously healthy 46-year-old woman comes to the office complaining of generalized muscle weakness, increased urination and thirst, and headache. She denies fever, chills, weight loss, night sweats, flushing, dysuria, and hematuria. Past medical history is significant only for normal, spontaneous, vaginal deliveries 17 and 20 years ago. She has no previous surgical history. She denies any abnormal menstrual cycles. She takes no medications and denies alcohol, tobacco, or illicit drug use. Her temperature is 37.0 C (98.6 F), blood pressure is 154/102 mm Hg without orthostatic changes, pulse is 72/min, and respirations are 12/min. She is in no distress. Her heart has a regular rate and rhythm without murmurs. There are no palpable abdominal masses. Extremities have no ecchymoses, cyanosis, clubbing, or edema. Complete blood count is normal. A CT scan of the adrenal glands shows a 1-cm adrenocortical adenoma on the left side. Evaluation of her serum electrolytes is most likely to show which of the following abnormalities?

A. Decreased potassium, decreased sodium
B. Decreased potassium, elevated sodium
C. Decreased potassium, normal sodium
D. Elevated potassium, normal sodium
E. Normal potassium, elevated sodium
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Old 10-18-2011
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adrenal adenoma . primary aldosteronism. - elevated sodium , dec pottasium.
ans BBBBBBBB
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Old 10-18-2011
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Primary aldosteronism,

B,Decreased potassium, elevated sodium
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Old 10-18-2011
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I believe aldosterone increases total body Na+ & reduces plasma K+, I will go for:
C. Decreased potassium, normal sodium
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Old 10-18-2011
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The correct answer is B. Conn's syndrome is defined as adrenal hypersecretion of aldosterone in the hypertensive, nonedematous patient. It accounts for approximately 1% of the hypertensive patients in the United States. Women with this diagnosis outnumber men by 2:1. The typical patient is 30-50 years old. Clinical suspicion for primary hyperaldosteronism should be entertained in any hypertensive patient with spontaneous hypokalemia (potassium <3.5 mEq/L). Patient complaints include muscle weakness, polyuria, and headache. The headaches are secondary to hypertension. Muscle weakness, polyuria, and paresthesias relate to the effect of hypokalemia on skeletal muscle, the renal concentrating mechanism, and peripheral nerves, respectively. Laboratory analysis shows hypokalemia, dilute urine with pH >6.5, elevated serum bicarbonate, and mild metabolic alkalosis. Aldosterone is an important component of the rennin-angiotensin-aldosterone axis. Aldosterone seeks to restore circulating blood volume. It does this by acting on the distal tubule and collecting system of the kidney to cause secretion of K+ and, to a lesser extent, H+ in exchange for sodium. The retained sodium osmotically causes water to be reabsorbed into the body. This results in hypokalemic, hypernatremic, metabolic alkalosis. Choices A, B, D, and E are therefore incorrect.
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Old 10-18-2011
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Since Na retained water with it, no hypernatremia, but the total body Na is increased, not the plasma level.
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http://emedicine.medscape.com/article/117280-workup

http://books.google.com/books?id=bve...tremia&f=false
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