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10 Cards in this Set
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A 35 year old engineer was referred for evaluation and treatment of HTN. He has taken diuretics (hydrochlorothiazide), ACE inhibitor (lisonpril), and a β-blocker (atenolol) with no effective reduction in his blood pressure. He occasionally has headaches. At the visit, his blood pressure was 180/110. He had a pulse of 100. Other finidings included mild diabetes mellitus, with a random blood sugar of 201 mg/% and mild postural hypotension one minute after standing from a supine position.
You place the patient on a high dose of a β-blocker to reduce the HTN. To your surprise, his BP increases to 210/140. What happened? |
Things of note:
- He's on 3 different drugs for HTN but is not responding. - He has headaches (think pheo) - Postural hypotension means that he is volume depleted. - Test for Cushing's = 24 hr urine for cortisol - Test for Pheo = 24 hr urine for catecholamines and metabolites. The answer is pheochromocytoma |
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A 50 year old lawyer is referred for weak legs. He has difficulty raising his legs to put on his pants. He has not been able to climb stairs for one year. He smokes a pack of cigarettes daily. He has mild telangiectasia (excessive vascularity) of his face, cannot raise his arms above his head, and his abdomen is rotund. His brother mentions that the patient is forgetful. On exam, his blood pressure is 160/90. Lab data show blood glucose of 220 mg/% and low potassium.
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Things of note:
- Weak legs = proximal weakness - Smoking could indicate a SCLC paraneoplasm. - Telangiectasia could indicate cortisol excess. - Truncal obesity - MS changes - HTN - Hyperglycemia = cortisol overload - Low potassium = mineralocorticoid dependent HTN - Should do 24 hr urine and dexamethasone (low dose and high dose) test. |
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A 55 yo woman has a CT scan done in a drop in center. The CT shows a 2 cm nodule in the left adrenal. The patient feels fine and takes no meds, but was concerned.
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Adrenal incidentaloma. Figure out if it is benign or malignant.
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A 50 yo woman has developed increased hair growth on ther arms, legs, and face, over the past six months. Her voice has deepened.
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Adenoma (common)
Carcinoma (rare) CAH Can measure the sulfated form of DHEA |
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A 65 yo retired engineer was referred by her PCP for evaluation of a tumor of the sella tursica. The pt has mild HA, fatigue, cold intolerance, and occasional bilateral, nightly muscle cramps in her legs. Although normally a careful driver, she had run a stop sign 2 weeks ago. Her visual exam was abnormal.
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A 34 yo man experienced right hip pain for 6 months. His PCP found decreased range of motion of the right hip, but also noticed that the patient's facial features had become coarse. In addition, the pt had developed bilateral carpal tunnel and mild proximal muscle weakness of his arms and legs and has had difficulty arising from a sitting position).
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A 28 year old female, mother of 5 and 7 yo daughters, visits you for evaluation of bilateral galactorrhea fo 6 months duration. She takes no medications other than an occasional asprin.
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You are evaluating a 17 y.o. obese adolescent. He is accompanied by his mother who has many questions regarding his obesity.
1. She wishes to know what factors generally lead to obesity and what other endocrine disorders could lead to obesity. |
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You are evaluating a 17 y.o. obese adolescent. He is accompanied by his mother who has many questions regarding his obesity.
2. She wishes to know wat her son's risk of developing diabetes is and what other medical problems he is at risk of developing given his obesity. |
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You are evaluating a 17 y.o. obese adolescent. He is accompanied by his mother who has many questions regarding his obesity.
3. Finally, she wants to know what treatment options are available to her son. |
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