Question

Part III - One Year Later About a year later, Mr. Smith suddenly began to experience increasing muscle weakness, cramping and tingling, palpitations, generalized fatigue and recurrent headaches. One day he felt very uneasy and asked his coworkers to take him to the emergency room. On physical examination the only significant findings were a documented blood pressure of 210/120 mmHg, a heart rate of 110 bpm and moderate peripheral edema. The rest of his evaluation at the ER revealed the following: Mr. Smith Normal Values Na = 149 mEq/L 135-145 mEq/L K= 2.8 mEq/L 3.5-5.0 mEq/L CI= 108 mEq/L 98-108 mEq/L CO, = 16 mmol/L 20 to 29 mmol/L Blood urea nitrogen = 27 mg/dL 7-20 mg/dL Creatinine = 2.1 mg/dL 0.8 to 1.4 mg/dL Glucose = 123 mg/dL 64 to 128 mg/dL Mg = 1.3 mEq/L 1.5-2.0 mEq/L Additional routine tests which included a complete blood count (CBC), a chest X-ray and a 12 lead EKG were all unremarkable. An arterial blood gas (ABG) analysis was consistent with a mild metabolic alkalosis with some degree of compensation. An abdominal ultrasound study revealed a suspicious small mass at the level of the right adrenal cortex. Further imaging evaluation with high-resolution CT scan confirmed an adrenal adenoma of the right adrenal cortex. Based on the CT scan results Mr. Smith underwent surgery for removal of the adrenal tumor. Post-operatively, Mr. Smith recovered well without complications and with significant improvement of all his symptoms. His blood pressure began to normalize gradually and after just a few weeks, his doctor was able to completely discontinue all blood pressure medications with no further complaints. Questions I le a from this meant to ingenia Biecome a shampoonible causes. 2. Desert DICT. etway. 3. Esm . ciancondemne hyperaldostCTUMISI 4. What is the main pathophysiologic process responsible for this patient's symptoms? 5. Would you classify this type of hypertension as primary essential) or secondary? 6. What other important blood test could be used to diagnose this condition? 7. What is the treatment of choice for this particular case?

Answer 1

4 - If functional, Adrenocortical adenomas can affect the normal activities of the adrenal cortex. Located within the adrenal glands are three zones that are responsible for the secretion of the three major classes of adrenal steroids. Hence, functional adrenal adenomas can induce over-secretion of adrenal steroids associated with pure or mixed endocrine syndromes, a condition commonly known as hyperadrenalism.

5 - Hypertension associated with adrenal adenomas is secondary hypertension.

6 - Blood cortisol level

Blood dopamine level

Bloodnorepinephrine

Blood epinephrine

Blood levels of adrenal androgens

7 - Treatment of choice

Non-surgical

Medication
Doctors can manage the symptoms of patients with functioning tumors (tumors that produce excess hormones) through medication. Different medicines are prescribed for Cushing's syndrome, Conn 's syndrome, and excessive androgen production.

Medication to suppress adrenal gland function is used for patients who have a malignant (cancerous) adrenal tumor that can't be removed by surgery.

Surgical

Adrenal adenomas can be cured by removing the adrenal gland that has the tumor, using laparoscopic surgery. You will be under general anesthesia, unconscious and unable to feel any pain. The surgeon will make several short cuts in your abdomen, and pass a tiny video camera and surgical instruments through these incisions. The camera sends images from inside the body to a TV monitor. Guided by these images, the surgeon uses the surgical tools to remove the adrenal gland.

A doctor may recommend removing a malignant (cancerous) adrenal tumor by removing the adrenal gland by surgery. They may also elect to treat the tumor with chemotherapy or radiation therapy.