High aldosterone, hypertension and adrenal adenoma in a 36-year-old pregnant patient: Is this primary aldosteronism?

A 36-year-old woman presented at 16 weeks’ gestation with severe hypertension. In comparison to the non-pregnant reference normal ranges, potassium was 3.1-3.9 mmol/L, aldosterone 2570-3000 pmol/L (N 250-2885) renin was unsuppressed (24-76.4 ng/L (N1.7–23.9)), with aldosterone to renin ratios in the reference range. An adrenal MRI scan demonstrated a 1.8 × 1.4 cm left adrenal adenoma. Primary aldosteronism was strongly suspected and surgery considered. However, she was managed conservatively with labetalol and modified-release nifedipine with no obstetric complications. Post-partum blood pressures remained elevated with normal aldosterone (539 pmol/L), unsuppressed renin (5.2 ng/L) and normal aldosterone-to-renin ratio (104 (N \u3c 144)). Suspected primary hyperaldosteronism is challenging to investigate and manage in pregnancy. The accepted screening and confirmatory tests are either contraindicated or not validated in pregnancy. Pregnancy has significant effects on the renin-angiotensin-aldosterone pathway leading to physiologic elevations in both aldosterone and renin. While primary hyperaldosteronism has been associated with poor pregnancy outcomes, optimal management in pregnancy is not clearly established

Communication Skills assessed at OSCE are not affected by Participation in the Adolescent Healthy Sexuality Program

We proposed that first year medical students who voluntarily participated in the Healthy Sexuality adolescent program would perform better than their peers on an adolescent counseling station at the year-end OSCE (Objective Structured Clinical Examination). In addition we compared medical students communication skills at the time of the program as assessed by self, peers and participating adolescents. Methods: Nineteen first year medical students voluntarily participated in the ongoing Healthy Sexuality program. Adolescent participants, medical student peer participants and medical students assessed communication components on a 7-point Likert scale at the end of the program. At the year-end OSCE, all first year medical students at the University of Western Ontario were assessed at an adolescent counseling station by a standardized patient (SP) and a physician examiner. Statistical analysis examined differences between the two groups. Results: Students who participated in the Healthy Sexuality program did not perform better than their colleagues on the year-end OSCE. A statistically significant correlation between physician examiner and SP evaluations was found (r = 0.62). Adolescent participants communication skills assessments in the Healthy Sexuality Program demonstrated no significant correlation with medical student assessments (self or peer). Conclusions:Voluntary intervention with adolescents did not result in improved communication skills at the structured year-end examination. Further investigation will be directed towards delineating differences between SP and physician examiner assessments