hypertension + hypokalemia suggests…
primary hyperaldosteronism! esp if aldosterone levels fail to fall w/ saline infusion
questions to ask w/ impotence…
- libido and morning erections (psych issue?)
- w/ dec libido: check testosterone and if low, check gonadotropins
- in diabetic w/ vascular complications, inject paparevine -normal w/ erection w/in 10 minutes
90 y/o with hip and bone pain, hearing loss, headaches and tinnitus. enlarged skull w/ bone deformities in knees. elevated alk phos on exam…dx?
PAGET’S!
-unknown cause - get increased bone resorption and it is replaced w/ disorganized trabecular bone
paget’s tx…
- often asx, no tx
- pain: NSAIDS and w/ more significant do bisphosphonates (1st line)
- if not tolerated do calcitonin
patient presents w/ weakness, fatigue, hypotension and bronze elbows….?
ADDISONS!!!
-can be side effect of TB!
addisons dx…
check serum am cortisol and cosynitropin stim test
*expect low sodium and high potassium on exam
addisons tx…
- hydrocortisone 20-30 mg/d (2/3 in am and 1/3 pm) and fludracortisone .5-1 mg/d
pt w/ palpitations, apprehension and hyperglycemia suggests…
pheochromocytoma!
arrhenoblastoma…
1 androgen producing ovarian tumor - will have normal cortisol w/ increased testosterone and masculinization
patient w/ cervical fat pad, purple striae and hirsutism, muscle wasting…
cushings!!!
-easy bruising and amenorrhea and psych symptoms also seen
bitemporal hemianopsia……suggests?
prolactinoma!
-also see amenorrhea, galactorrhea and serum prolactin >250!
empty sella syndrome..
enlarged sella turcica d/t increased CSF pressure - no focal findings, common in obese hypertensive patients
-often have chronic headaches but normal pituitary function
