Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Aplastic Anemia Appendicitis 153

■complete responders to therapy (normalization of blood counts off

all therapy) probably have a normal life expectancy

Apparent Mineralocorticoid Excess.......................

MICHEL BAUM, MD

history & physical

■Hypertension

tests

■Hypokalemic alkalosis with low plasma aldosterone and renin

■Elevated urinary cortisol metabolites

differential diagnosis

■Autosomal recessive: Absence of 11-beta hydroxysteroid dehydroge-

nase (11-beta OH dehydrogenase), which inactivates cortisol – in the

absence of 11-beta OH dehydrogenase, cortisol binds to the miner-

alocorticoid receptor, resulting in mineralocorticoid action in distal

nephron

■Acquired: 11-beta OH steroid dehydrogenase inactivated by gly-

cyrrhizic acid in black licorice and chewing tobacco

■Distinguish from other causes of hypertension

management

■Low-salt diet

specific therapy

■Low-salt diet

■Amiloride or triamterene to block sodium channel in distal nephron

follow-up

■To ensure control of hypertension

complications and prognosis

■Complications secondary to hypertension

Appendicitis........................................

MARK A. VIERRA, MD

history & physical

History

■Most common in younger age groups