A 30-year-old Caucasian male presents to your office with fatigue, muscle weakness and occasional headaches. His blood pressure is 180/110 mmHg and his heart rate is 80/min. Laboratory evaluation reveals low serum potassium, severely depressed plasma renin activity, and a CT scan demonstrates a right-sided adrenal mass. After treatment for several weeks, the patient's symptoms resolve, his blood pressure is decreased to 130/70 mmHg and his heart rate is 75/min. Which of the following drugs was most likely used in this patient?

Question

A 30-year-old Caucasian male presents to your office with fatigue, muscle weakness and occasional headaches.  His blood pressure is 180/110 mmHg and his heart rate is 80/min.  Laboratory evaluation reveals low serum potassium, severely depressed plasma renin activity, and a CT scan demonstrates a right-sided adrenal mass.  After treatment for several weeks, the patient's symptoms resolve, his blood pressure is decreased to 130/70 mmHg and his heart rate is 75/min.  Which of the following drugs was most likely used in this patient?

Quizplus · Accepted Answer

This patient is suffering from an aldosterone secreting tumor (adenoma) leading to primary hyperaldosteronism (Conn's Syndrome). Presenting signs of hyperaldosteronism most commonly include hypertension, hypokalemia, metabolic alkalosis and decreased plasma renin activity. Aldosterone causes resorption of sodium and water and wasting of potassium and hydrogen ions (acid) at the distal portion of the nephron, leading to hypokalemia and alkalosis. Additionally, inappropriately high aldosterone will suppress renin activity as part of a feedback inhibition loop. The treatment for a unilateral adenoma secreting aldosterone, as is found in this patient, can be either by surgical resection or by medical therapy with aldosterone antagonists. Spironolactone is the most frequently used first-line drug, and eplerenone is a new aldosterone antagonist that has fewer side effects than spironolactone and is often used in those that can not tolerate spironolactone. The most frequently mentioned side effect of these medications is their ability to cause gynecomastia (approximately 1% with eplerenone, 9% with spironolactone). Other drugs mentioned in the other choices are not commonly used in Conn's syndrome. Educational objective: Aldosterone excess will cause hypertension, hypokalemia, metabolic alkalosis and depressed renin. Alternatively, hypoaldosteronism is the cause of type IV renal tubular acidosis. Aldosterone antagonists such as spironolactone or eplerenone can be used as medical therapy for Conn's syndrome. __________ References: Treatment of primary aldosteronism. (http://www.ncbi.nlm.nih.gov/pubmed/21115161) The pharmacological treatment of primary aldosteronism. (http://www.ncbi.nlm.nih.gov/pubmed/16553572)

A 30-Year-Old Caucasian Male Presents to Your Office with Fatigue