RESUMO
BACKGROUND: We investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice. METHODS: We retrospectively reviewed 48 patients who had resistant hypertension (HTN) or hypokalemia with a biochemical diagnosis of primary aldosteronism and who underwent AVS from January 2009 to June 2017 at a tertiary referral hospital. Selection index (SI), lateralization index (LI), and contralateral suppression index (CSI) were calculated based on AVS results and the final clinical outcomes were evaluated. RESULTS: The catheterization of both adrenal veins was successful in 43 of 48 (89.6%) patients. The lateralization based only on LI was performed in 23 out of 43 (53.5%) patients. When CSI and LI were combined in decision making, the concordance between adrenal computed tomography scan and AVS for unilateral lesion improved from 59.3% (19/32) to 75.0% (24/32). CSI also correlated well with unilateral adrenal disease in the catheterization failure group. The final outcomes of HTN were better in the contralateral suppression group. CONCLUSION: CSI combined with LI could be a supplementary diagnostic tool in patients with non-lateralization or catheterization failure and predict the clinical outcomes of HTN in patients with primary aldosteronism.
Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Coleta de Amostras Sanguíneas/métodos , Indicadores Básicos de Saúde , Hiperaldosteronismo/diagnóstico , Veias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aldosterona/sangue , Cateterismo Periférico/métodos , Estudos de Coortes , Técnicas de Diagnóstico Endócrino , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Amostragem do Seio Petroso/métodos , Prognóstico , Estudos Retrospectivos , Adulto JovemAssuntos
Pressão Sanguínea/efeitos dos fármacos , Clortalidona , Hidroclorotiazida , Hipertensão , Hipopotassemia , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Determinação da Pressão Arterial , Clortalidona/administração & dosagem , Clortalidona/efeitos adversos , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Humanos , Hidroclorotiazida/administração & dosagem , Hidroclorotiazida/efeitos adversos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipopotassemia/induzido quimicamente , Hipopotassemia/diagnóstico , Hipopotassemia/prevenção & controle , Conduta do Tratamento Medicamentoso/normas , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reino UnidoAssuntos
Bloqueadores dos Canais de Cálcio/efeitos adversos , Diuréticos/efeitos adversos , Hipertensão/tratamento farmacológico , Hipertensão/enfermagem , Bloqueadores dos Canais de Cálcio/farmacologia , Diuréticos/farmacologia , Humanos , Hipopotassemia/induzido quimicamente , Hipopotassemia/diagnósticoRESUMO
OBJECTIVE: To assert the importance of the use of the healthcare matrix formulation for competency assessment in psychiatry residency training. METHODS: We present a case from our inpatient psychiatric facility and format it in the form of the healthcare matrix, which was developed at Vanderbilt University incorporating the Institute of Medicine 'aims' and the Accreditation Council for Graduate Medical Education 'core competencies'. We also analyze the healthcare matrix and elucidate its use in clinical practice. RESULTS: The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care, like the one in our psychiatric setting, and allows us to learn from the shortcomings in order to improve. CONCLUSION: The optimal utilization of this tool in the competency assessment of psychiatry residents has an enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format.
Assuntos
Competência Clínica/normas , Educação Baseada em Competências , Internato e Residência , Psiquiatria/educação , Convulsões/etiologia , Adolescente , Delírio/diagnóstico , Encefalite/complicações , Encefalite/diagnóstico , Encefalite/psicologia , Feminino , Humanos , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Transferência de PacientesRESUMO
Hypokalemia is an uncommon presentation of renovascular hypertension. Although renal artery stenosis has been associated with hypokalemia secondary to hyperreninemic hyperaldosteronism, few reports have actually evaluated the pathophysiologic changes in such a patient with renovascular hypertension. We studied a patient before and after surgical revascularization who presented with severe hypertension and marked, symptomatic hypokalemia. Before surgery, the patient had excessive urinary potassium secretion, markedly increased secretion of renin after captopril stimulation, and mild secondary hyperaldosteronism. Postoperatively, the patient's blood pressure decreased moderately and the serum and urinary potassium values normalized. After revascularization, plasma renin activity both before and after captopril stimulation and serum aldosterone levels decreased markedly. These findings demonstrate that renovascular hypertension may rarely present with symptomatic hypokalemia secondary to excessive aldosterone secretion. Improvement in the renal ischemic state is accompanied by rapid correction of the metabolic disturbances associated with hyperreninemic hyperaldosteronism.
Assuntos
Hipopotassemia/diagnóstico , Obstrução da Artéria Renal/diagnóstico , Aldosterona/sangue , Diagnóstico Diferencial , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/fisiopatologia , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/fisiopatologia , Hipertensão Renovascular/cirurgia , Hipopotassemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Potássio/urina , Artéria Renal/cirurgia , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/cirurgia , Renina/sangue , Artéria Esplênica/cirurgiaRESUMO
Potassium homeostasis is dependent on many physiologic and metabolic factors. Potassium level testing by the clinical laboratory can aid the emergency physician in planning treatment in suspected cases of potassium depletion or excess. Familiarization with indications for ordering tests of potassium level and correct interpretation of test results is essential for appropriate patient care.