Endocrine Update 2010

Emmanuel L. Bravo, MD Cleveland Clinic Dept. of Nephrology and Hypertension Glickman Urological & Kidney Institute S:\SLIDES\2010\Brvo\Endo-Updte-2010.ppt

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Case presentation • 29-year-old female • Hypertensive since age 24 years • “Difficult-to-control” BP despite taking diltiazem (300 mg once daily), metoprolol (50 mg twice daily), hydralazine (50 mg three times daily), and HCTZ (25 mg once daily) • Seen at ER for abdominal pains. BP 170/105 mm Hg. Serum K 2.1 mEq/L • HCTZ discontinued. Discharged on KCl, 40 mEq twice daily S:\SLIDES\2010\Brvo\Endo-Updte-2010.ppt

Simplified algorithm to determine the origin of hypokalemia in a hypertensive patient


1.20 nmol/L

• 24-hr urinary metanephrines – NMN >1500 µg – MN >600 µg

• Fractionated plasma NE + E >2000 pg/mL S:\SLIDES\2010\Brvo\Endo-Updte-2010.ppt

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Biochemical Findings Reliably Excluding the Presence of a Tumor (Negative Predictive Value = 100%) • Plasma-free fractionated metanephrines – NMN