A physician is reviewing the charts of four adult patients who each present with secondary hypertension or systemic vasoactive symptoms. Match each patient's clinical presentation with the most appropriate initial targeted laboratory evaluation required to establish the underlying diagnosis.
- A 35-year-old patient with refractory elevated blood pressure despite adherence to a three-drug regimen, who recently developed muscle cramps and is found to have a spontaneous serum potassium of 2.9 mEq/L.Plasma aldosterone concentration to plasma renin activity ratio
- A 42-year-old patient with new-onset elevated blood pressure, progressive central adiposity, wide violaceous abdominal striae, and marked proximal muscle weakness.24-hour urinary free cortisol or 1-mg overnight dexamethasone suppression test
- A 29-year-old patient with paroxysmal elevated blood pressure, accompanied by discrete, sudden episodes of severe headaches, rapid palpitations, and generalized hyperhidrosis.Plasma cell-free metanephrines or 24-hour fractionated metanephrines
- A 55-year-old patient with fluctuating blood pressure, chronic unexplained watery diarrhea, episodic facial flushing, and a newly auscultated tricuspid regurgitation murmur.24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion
Cevap
The correct pairings match the hypokalemic hypertensive patient with the aldosterone-to-renin ratio, the patient with central adiposity and striae with urinary free cortisol testing, the patient with episodic headaches and sweating with plasma cell-free metanephrines, and the patient with flushing and diarrhea with urinary 5-HIAA.
Each patient exhibits a classic phenotypic presentation of a distinct endocrine or neuroendocrine disorder that requires a specific, validated initial biochemical test to demonstrate hormone excess prior to any localization studies.
Adım Adım Çözüm
Anahtar Kavram
Targeted initial biochemical screening for secondary causes of hypertension and vasoactive syndromes based on specific clinical phenotypes.