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Zorluk: OrtaGeneral Internal Medicine

A physician is evaluating an adult patient with newly diagnosed, severe, and resistant hypertension. The physician considers various secondary causes based on the patient's history and subtle physical exam clues. Match each suspected secondary cause of hypertension with its most appropriate initial screening test.

  • Primary hyperaldosteronismPlasma aldosterone concentration to plasma renin activity ratio
  • PheochromocytomaPlasma free fractionated metanephrines
  • Renovascular hypertensionDuplex Doppler ultrasonography of the renal arteries
  • Cushing syndromeOvernight 1-mg dexamethasone suppression test

Cevap

Primary hyperaldosteronism matches with the aldosterone-to-renin ratio. Pheochromocytoma matches with plasma metanephrines. Renovascular hypertension matches with renal ultrasound. Cushing syndrome matches with the dexamethasone suppression test.
Each secondary cause of hypertension is paired with its guideline-recommended initial screening test. Screening tests are chosen for their high sensitivity to rule out the condition. The PAC/PRA ratio detects autonomous aldosterone; plasma metanephrines detect catecholamine breakdown; duplex ultrasound visualizes renal artery stenosis; and the low-dose dexamethasone test identifies a failure to suppress endogenous cortisol production.

Adım Adım Çözüm

1
Identify the underlying pathophysiology of each secondary hypertension cause.
Recognize that primary hyperaldosteronism involves aldosterone excess, pheochromocytoma involves catecholamine excess, renovascular disease involves impaired renal perfusion, and Cushing syndrome involves cortisol excess.
Understanding the pathophysiologic mechanism dictates which hormone or organ system needs to be evaluated.
2
Select the most appropriate, sensitive, and least invasive initial screening modality for each condition.
Match each condition to its standard initial diagnostic test according to current clinical guidelines.
Accurate initial screening is required to select patients who need further, often more invasive, confirmatory testing.

Anahtar Kavram

Initial diagnostic screening tests for secondary causes of hypertension.
Tahmini Süre:1m 0s
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General Internal Medicine

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