qbank question

[YellowTurtle]

Came across this question.

Young woman with weakness/paresthesias. Began 3 weeks ago, worsening. PMH unremarkable, taking no meds. BP was found to be elevated 6 months ago at a health fair, she dismissed it bc she was stressed at the time. BP is now 190/100. Phx unremarkable. Lab = very low plasma renin and normal serum Cr.

Gives a list variations of possible lab values and asks which one is most likely.

The correct lab values are ones that say she has hyperaldosteronism. But with no imaging to show enlargement of the adrenals, how can you differentiate this presentation from SIADH?

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[deleted763299]

SIADH causes HYPOnatremia. Hyperaldosteronism causes HYPERnatremia.

 

[YellowTurtle]

Yeah but the stem didn't provide her lab values. You were supposed to choose which set of values would be hers.

It was like:
A. hypernatremia, hypo......., normal bicarb
B. hyponatremia, hyper ....., elevated bicarb
etc.

I chose the one with hypOnatremia thinking she could have SIADH, but apparently it was incorrect.

 

[Cytarabine]

Siadh doesn't present with htn. You also have lab evidence of primary hyperaldo with the renin. Sx from hypoK

 

[Ismet]

Moving to Step 1 forum.

 

[dfib slim]

Hypertension with low renin is classic for Conn Syndrome.

 

[soop]

SIADH causes HYPOnatremia. Hyperaldosteronism causes HYPERnatremia.

Correct me if I'm wrong here, but doesn't hyperaldosteronism typically present with normal sodium due to aldosterone escape?

 

[zhopv10]

The aldosterone escape prevents you from getting catastrophically high sodium but the sodium is still elevated in conn syndrome


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[Cytarabine]

The aldosterone escape prevents you from getting catastrophically high sodium but the sodium is still elevated in conn syndrome


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The "hypok" also tends to be low side of normal K, but something like an episode of diarrhea can tip them over to real hypok much easier than a healthy person

 

[wjs010]

If the lab values point toward conn syndrome, it should be distinguishable. Siadh would have low Na, whereas conn would have high Na.


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[wjs010]

Yeah but the stem didn't provide her lab values. You were supposed to choose which set of values would be hers.

It was like:
A. hypernatremia, hypo......., normal bicarb
B. hyponatremia, hyper ....., elevated bicarb
etc.

I chose the one with hypOnatremia thinking she could have SIADH, but apparently it was incorrect.

Which qbank? Sounds like an incorrect correct answer. An example of classic siadh from sclc, is Na levels in the 120s. That is ALWAYS siadh. I'm not sure at what point aldosterone escape stops working ( to where you would have very high BP) but I think usual questions would provide high Na for any primary hyperaldosterone cases. Uworld was just super cheeky with that aldosterone escape stuff


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