内分泌英文病历讨论(学生版)

Case Discussi on

A 35-year-old pregnant woman (gravida 2 胎次,para 1) was admitted to this hospital at 19 weeks and 6 days of gestatio n 怀孕期because of the recent on set of hyperte nsion and diabetes.

Three weeks before admission, at a routine prenatal visit, her blood pressure was 150/100(150 over 100) mm

Hg(millimeters hydragyrim). On the same day she saw her primary care physicia n, who recorded a blood pressure of 172/102 mm Hg. The results of a physical exam in ati on were normal. Urinalysis showed glucose (4+). The results of other laboratory tests are shown in Table 1. The n ext day, the blood pressure was 180/100 mm Hg. The blood glucose level 1 hour after the oral adm ini strati on of glucose (50 g) was 346 mg per deciliter [?desili:t?]分升(19.2 mmol per liter). Treatment with labetalol 拉贝洛尔，glyburide 格列本脲(优降糖) ，and potassium [p???si?m]乍钾suppleme nts was in itiated. The results of fetal ultraso und exam in ati on were normal for the gestational age of the fetus [?fit? s]. Three weeks later, despite increasing doses of labetalol, the patient's blood pressure remained in the range of 180/110 mm Hg and her fasting blood glucose level ran ged betwee n 140 and 180 mg per deciliter (7.8 and 10.0 mmol per liter); the patie nt was admitted to the hospital.

The patient had gained 6.8 kg in weight during the pregnancy. She had recently had polyuria and polydipsia and in creased facial puffin ess 虚胖;her complexi on 面色was chroni cally ruddy 红润. She did not have headaches, proximal muscle weakness, bruising 挤压伤,flushing 激动脸红, abdominal pain, edema, palpitations 心悸, diaphoresis [,dai?f?ri:sis]发汗(sweat), edema, or cha nges in visi on. Her men ses had bee n regular before preg nancy, and she had had no difficulty conceiving 怀胎with either this pregnancy or a pregnancy 3 years earlier, during which she had mild, diet-c on trolled gestati onal diabetes. She had bee n mildly overweight, with a body-mass index ( BMI) (the weight in kilograms divided by the square of the height in meters) of approximately 25 for several years. She did not smoke, drink alcohol, or use illicit [ ?l?s?t]非法的drugs. She was married, with a 2-year-old daughter. Her mother and maternal [m ??:?:nl]母亲方面的grandmother had type 2 diabetes mellitus, and many family members had hypertension.

Q1: What' sthe possible cause of the patient? Give 3 or more diseases for hypertension duri ng preg nan cy.

1.preeclampsia or eclampsia

2.chr onic hyperte nsion probable diag no sis

3.preeclampsia or eclampsia superimposed on chronic hyperte nsion

4.gestati onal hyperte nsion

When I saw this patient during her first admission, she had marked hypertension, poorly controlled diabetes mellitus, and hypokalemia. The four hypertensive disorders that are recognized during pregnancy are preeclampsia [?pri?Kl?mpsi ?]先兆子痫or eclampsia [ek?l?mpsi?] 子痫惊厥,chronic hypertension (including "essential" hypertension and secondary hypertension), preeclampsia or eclampsia superimposed [?sju:p?rim?p/&zd] on chronic hypertension , and gestational hypertension . Although this patient had proteinuria, it was not severe enough to warrant 正当理由 a diagnosis of

preeclampsia; in addition, the onset of preeclampsia would be unlikely this early in the pregnancy. Gestational hypertension WOuk Le unlikely this early in pregnancy. Thus, I was left with a probable diagnosis of chronic hypertension.

In a patient with newly diagnosed chronic hypertension, the major question is whether it is essential hypertension or associated with another condition . A pregnant patient with chronic hypertension is at increased risk for superimposed preeclampsia, intrauterine子宫内的growth restriction(grow slowly), abruption 分裂placentae [pl?会ent?]胎盘(胎盘早剥正常20week to birth), premature birth, and perinatal [?peri?neitl]

围产期death. Efforts to control blood pressure with labetalol or methyldopa 甲基多巴to reduce the incidence of preeclampsia and its associated perinatal morbidity 发病率have been disappointing; thus, a search for a secondary cause in a case such as this is mandatory 必要的强制的.In this patient, the presence of hypokalemia increased my suspicion that the problem was secondary hypertension.