Here - American Geriatrics Society

P OSTER
A BSTRACTS
is a paucity of literature about this unique subgroup of patients. Sarcoidosis
is a systemic illness that typically presents in younger populations;
peak incidence is between the ages of 20-40. Typical symptoms
on presentation are systemic malaise, fever, and pulmonary
complaints. There is a gender predilection with women being affected
more often than men, and a racial predilection with African Americans
affected more so than Caucasian populations.
Case: An 81 year old Caucasian man with a medical history of
coronary artery disease, chronic obstructive pulmonary disease, and
laryngeal cancer status post resection presented with a three week
history of decline characterized by weakness, confusion, and frequent
falls. Upon admission the patient was found to have an elevated calcium
level of 13.5 mg/dL. Chest roentogram was unremarkable, but
computed tomography of the chest with contrast revealed mediastinal
lymphadenopathy. Lab results demonstrated parathyroid hormone
(PTH) 20. The captopril challenge test confirmed
the results in 2 patients, while Case 2 had an elevated ratio twice. CT
scans of the abdomen were performed in 2 cases, revealing normal adrenal
glands. All 3 patients were diagnosed with primary aldosteronism
(PA) and were treated medically with spironolactone. In Case 1
and 2, all BP medications were discontinued with the exception of
spironolactone (50 mg daily in Case 1 and 125 mg daily in Case 2). In
Case 3, BP improved with the addition of spironolactone 125 mg daily.
Discussion: Idiopathic PA peaks in the sixth decade of life. PA
has a prevalence of 5-15%. These 3 cases were found within a small
primary care clinic panel of 215 patients. PA can commonly be found
in a community-based primary care geriatric clinic setting (not just in
specialized HTN referral centers). These cases had been treated as essential
HTN for 1-2 years before diagnosis. The diagnosis may frequently
be missed if not considered, including in HTN patients without
hypokalemia. The Endocrine Society recommends that patients
who have BP>160/100, or drug-resistant HTN, or HTN with spontaneous
or drug-induced hypokalemia be screened for PA. In Case 1
and 2, polypharmacy was markedly reduced. In Case 3, although BP
improved, polypharmacy was not reduced, perhaps suggesting PA
plus essential HTN. Even if the diagnosis of PA was a false positive,
spironolactone is an effective BP medication to be considered in
drug-resistant HTN. More importantly, there is now evidence to suggest
that aldosterone excess in PA leads to adverse cardiovascular
and renal outcomes independent of its effects on BP. Treatment
specifically directed against aldosterone excess protects against the
development of these complications more effectively than non specific
BP medications, further emphasizing the importance of not missing
the diagnosis of PA.
B9 Encore Presentation
Bilateral popliteal vein aneurysms: a rare cause of leg pain.
F. Cardona, 1 T. T. Suh, 1 M. Sideman. 2 1. Division of Community
Geriatrics, Department of Family and Community Medicine, UTH-
SCSA, San Antonio, TX; 2. Division of Vascular & Endovascular
Surgery,Department of Surgery, UTHSCSA, San Antonio, TX.
BACKGROUND: Although popliteal vein aneurysms (PVAs)
are the most common reported venous aneurysms, they are still rare
AGS 2012 ANNUAL MEETING
S75