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Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Many women with chronic hypertension are under the care of a primary care physician and already have been evaluated for causes of secondary hypertension, such as primary aldosteronism, pheochromocytoma, or Cushing’s disease (3). Women with paroxysmal hypertension, frequent “hypertensive crisis,” seizure disorders, or anxiety attacks should be evaluated for pheochromocytoma with measurements of 24-hour urine vanillylmandelic acid, metanephrines, or unconjugated catecholamines (10). Primary aldosteronism is rare in pregnancy, but may present with hypokalemia. Imaging studies (magnetic resonance imaging or computed tomography) may be helpful in demonstrating or localizing an adrenal tumor. Doppler flow studies or magnetic resonance angiography can reveal renal artery stenosis (3).
DRCOG MCQs for Circuit B Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Per vagina (PV) bleed in an 8-year-old girl may be associated with:Sarcoma botyroides.Urethral prolapse.Granulosa theca cell tumour.Dysgerminoma.Adrenal tumour.
Endocrinology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Mehul Dattani, Catherine Peters
Pituitary-dependent Cushing disease is usually treated by trans-sphenoidal removal of the adenoma by an experienced neurosurgeon. Where an adrenal tumour is defined, surgical removal of the tumour is indicated. Medical treatment with metyrapone or ketoconazole may be required to suppress cortisol production but is not without its own problems and is generally used as a temporary measure. Adrenalectomy is usually indicated in cases of adrenal neoplasms or multi-nodular adrenal hyperplasia, although subtotal resection may be an option in certain cases.
Management of a multiple endocrine neoplasia type 1 during pregnancy: a case with primary hypertension
Published in Gynecological Endocrinology, 2022
Jianyi Li, Dabao Xu, Xinli Liu
From first trimester to 22 weeks gestation, the pregnancy was uneventful, amniocentesis was refused. At 23 weeks, the patient was hospitalized to our clinic again for elevation of blood pressure. Blood pressure at that time was 180/117 mmHg, serum prolactin and phosphorus level were 2.08 mmol/L and 0.82 mmol/l, PRL at that time was measured as 135.8 ng/ml, HbA1C level was 5.8%, 24-h proteinuria value was 3331.2 mg, the levels of thyroid function, PTH, hepatorenal function were all in normal range. Aldosterone, angiotensinI/II,renin activity, cortisol, ACTH, abdominal CT were performed to examine whether left adrenal tumor developed from nonfunctioning to functioning or new lesion in adrenal gland existed, results showed that the biochemical tests were all in normal range and abdominal CT showed the same as before. Chronic hypertension with severe preeclampsia was diagnosed and induced abortion was suggested, the patient declined, nifedipine controlled release tablet and oral protein powder were added, 24-h proteinuria and liver function were monitored, one week later, Blood pressure was controlled at normal level, serum albumin and 24-h proteinuria levels were 32.1 g/l and 1082 mg, another 10 days passed, serum albumin and 24-h proteinuria levels were tested again and the results were 30.7 g/l and 1953 mg. At 29 weeks gestation, serum prolactin and phosphorus levels were 2.22 mmol/L and 0.66 mmol/l, serum albumin and 24-h proteinuria levels were 30.7 g/l and 2603 mg, steroid injections for fetal lung maturity was used.
Secondary hypertension as a cause of treatment resistance
Published in Blood Pressure, 2023
Isabella Sudano, Paolo Suter, Felix Beuschlein
Both phaeochromocytoma and paraganglioma are uncommon tumours that account for less than 0.1% of all hypertensive cases [1]. The clinical presentation of phaeochromocytomas is quite variable, ranging from severe, causing emergencies and sudden death, to those cases with minimal or no symptoms. In the latter, the diagnosis is often initiated following abdominal imaging with an incidental finding of an adrenal tumour. Commonly described symptoms are headache, flushing, palpitations, anxiety, chest pain, dyspnoea, abdominal pain, diarrhoea, blurred vision, dizziness, weakness and fatigue, anorexia and weight loss, polyuria, and polydipsia; clinical signs include arterial hypertension (stable or hypertensive crisis), tachycardia, orthostatic hypotension, and heart failure [27].
Survival benefits of computed tomography-guided thermal ablation for adrenal metastases from hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2019
Ning Lyu, Yanan Kong, Tao Pan, Luwen Mu, Xuqi Sun, Shaolong Li, Haijing Deng, Jinfa Lai, Ming Zhao
Evaluations of technical success, effectiveness, and complications were based on per-lesion ablation. Adrenal tumor progression rates and survival outcomes were assessed on a per-patient basis. Survival was estimated using the Kaplan–Meier method and compared using log-rank tests. A Cox regression model was used for the evaluation of factors predicting survival. Statistically significant variables in the univariate analysis were included in the multivariate analysis. A p values of <.05 was considered statistically significant. All statistical analyses were performed using SPSS version 17.0 (SPSS, Chicago, IL). All data were recorded at Sun Yat-Sen University Cancer Center (number: RDDA2018000952).