December 14, 2007 Archives - Page 2 of 6 - Clinical Advisor

Print Issue: December 14, 2007

WHEN DISCONTINUED MEDS COMPLICATE THE WORKUP OF SECONDARY HYPERTENSION

When ordering renin-to-aldosterone ratios in the workup of secondary hypertension, how does one deal with the severe hypertension that results when the patient discontinues both ACE inhibitors and diuretics before the blood draw?—Raymond S. Chen, DO, Monterey Park, Calif. If I am considering the diagnosis of hyperaldosteronism, which is associated with low renin and high…

WHAT’S BEHIND FIBROMYALGIA?

Has anyone found a pathophysiologic cause for fibromyalgia? The symptoms of fibromyalgia and various psychiatric illnesses are very similar, and I wonder if we should be treating a psychiatric condition rather than a medical one.—Bret Bellard, MD, Carson City, Nev. Pain amplification in fibromyalgia is likely caused by neurohormonal abnormalities in the central nervous system.…

TREATING DIABETIC PATIENTS FOR GALLSTONES

Should most asymptomatic gallstones in otherwise healthy diabetic patients be treated with elective cholecystectomy?—Robert E. Hollis Jr, MD, Fort Mitchell, Ky. Gallstones are more common in diabetic patients than in others, and there is some largely anecdotal evidence that diabetics are at increased risk for developing severe gangrenous cholecystitis. This information led some authorities in…

CHECKING PSA IN A PROSTATITIS PATIENT

When should I check the prostate-specific antigen (PSA) level of a 43-year-old man with a clinical diagnosis of acute prostatitis?—Haytham Kawii, MD, Baton Rouge, La. A yearly PSA determination and digital rectal exam are currently recommended as screening tests for prostate cancer in men over age 50. In patients with a risk factor, such as…

CHOLESTEROL LEVELS IN VASCULAR DISEASE

What are the appropriate cholesterol goals for patients with known (1) peripheral vascular disease or (2) cerebrovascular disease, independent of risk factors and congestive heart failure issues?—Paul G. Linder, MD, Pittsburgh I would apply the same guidelines that are used for coronary disease patients: total cholesterol <200 mg/dL, LDL 35 mg/dL.—Peter F. Cohn, MD (110-5)

POSTPONING THYROID SURGERY

A woman who was scheduled to have surgery for Graves’ disease must now wait for her endocrinologist to clear her. Her most recent thyroid studies are thyroid-stimulating hormone (TSH) <0.03 mU/L, free triiodothyronine (T3) 2.8 nmol/L, and free thyroxine (T4) 0.88 nmol/L. The patient has been hyperthyroid for years and has had prior surgeries without…

DO ALLERGIES CAUSE RHEUMATOID ARTHRITIS?

Are respiratory allergies a risk factor for rheumatoid arthritis (RA)?—Rosa Martinez, MD, Yakima, Wash. Neither respiratory nor other allergic disorders are considered risk factors for RA induction, although smoking is thought to predispose patients to rheumatoid joint and lung disease. Some patients with RA who take nonsteroidal anti-inflammatory drugs may aggravate their allergic disease, with…

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