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  #1  
Old 03-04-2013
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Question Metastatic prostate cancer and GI symptoms

A 72 year old man with history of metastatic prostate cancer is admitted with severe weakness and lethargy. He has been having vomiting and abdominal pain for the past two weeks. He also reports intermittent diarrhea alternating with constipation over the past 2 months. Three months ago, he was noted to have progressive prostate cancer despite therapy with bicalutamide and leuprolide. His PSA at that time was 300ng/ml. He was started on Ketoconozole at that time and he is compliant with it. His most recent visit to the outpatient clinic was 4 weeks ago at which time his PSA was 60ng/ml. On examination, his temperature is 98F, Heart rate is 130/min, Respiratory rate 20/min and Blood pressure 70/40 mm Hg. Chest is clear to auscultation and abdominal examination is benign. A CT scan of the abdomen reveals enlarged prostate and osteoblastic bone metastases in pelvis but no evidence of bowel obstruction. Urinalysis and Chest x-ray are benign. The patient is started on intravenous isotonic saline. Which of the following is the most appropriate next step in managing this patient?

A) Start Chemotherapy
B) Refer to Hospice
C) Intravenous Hydrocortisone
D) Start Norepinephrine drip
E) Intravenous Biphosphonates
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  #2  
Old 03-04-2013
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E) Intravenous Biphosphonates
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Old 03-04-2013
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I think this patient suffers from adrenal suppression caused by Ketoconazole therapy. hypotension+ severe weakness are the major clues...so start hydrocortisone..
his condition is not compatible with hypercalcemia induced by metastases as hypercalcemia will increase blood pressure and induce constipation rather than intermittent diarrhea...so no bisphosphonate...
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Old 03-05-2013
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I agree with the above post that
the answer is IV hydrocortisone.
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Old 03-05-2013
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Default C) Intravenous Hydrocortisone

C) Intravenous Hydrocortisone
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