RESUMO
A 91-year-old depressed woman had resistant hypertension despite a triple combination of anti-hypertensives, including a Ca-antagonist, an angiotensin receptor blocker, and a thiazide diuretic at optimal doses. She had hypokalemic metabolic alkalosis, elevated plasma cortisol and ACTH, and elevated urinary cortisol. The high-dose dexamethasone did not suppress the elevated ACTH and cortisol. The addition of spironolactone to her previous medications controlled and normalized hypertension, hypokalemia, and hormonal abnormalities within 4 months. Her blood pressure, serum electrolytes, and the hormonal states remained normalized for more than a year thereafter. Her depressed mental state also improved after spironolactone.
Assuntos
11-beta-Hidroxiesteroide Desidrogenase Tipo 2/fisiologia , Síndrome de ACTH Ectópico/diagnóstico , Hormônio Adrenocorticotrópico/metabolismo , Síndrome de Cushing/etiologia , Hidrocortisona/metabolismo , Hipertensão/etiologia , Receptores de Glucocorticoides/fisiologia , Receptores de Mineralocorticoides/fisiologia , Espironolactona/uso terapêutico , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/tratamento farmacológico , Síndrome de Cushing/fisiopatologia , Depressão/tratamento farmacológico , Depressão/etiologia , Depressão/fisiopatologia , Dexametasona , Diagnóstico Diferencial , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipopotassemia/etiologia , Hipopotassemia/fisiopatologia , Estresse Psicológico/complicaçõesRESUMO
Coronary spasm can usually be controlled by administration of Ca antagonists. However, there are some cases of coronary spasm whose attacks cannot be controlled even with large doses of Ca antagonist and/or its combination with nitrates. Here we describe the case of a 41-year-old man whose attacks of coronary spasm were resistant to the combined administration of nitrates, Ca antagonists, and a statin. The attacks were alleviated and disappeared after withdrawal of nitrates and recurred after readministration of a nitroglycerin patch. The involvement of nitrate tolerance in the pathogenesis of multidrug resistant coronary spasm was revealed and its implication discussed.