Which patient should be assessed first when considering hypertensive crisis and tremors in a Conn syndrome patient?

• A. A patient with Conn syndrome who experiences a blood pressure of 210/106 and tremors.
• B. A patient with Cushing disease after bilateral adrenalectomy.
• C. A patient with Addison's disease stable.
• D. A patient with hyperaldosteronism with no acute symptoms.

Answer: (A)

The key idea is that a hypertensive crisis demands immediate assessment and stabilization because it carries a high risk of rapid end-organ damage. In a Conn syndrome patient, a blood pressure of 210/106 accompanied by tremors signals an acute emergency that must be prioritized. Tremors can reflect sympathetic overactivity or hypokalemia-related neuromuscular irritability, both of which can accompany severe aldosterone-driven hypertension, so this presentation represents the highest-risk scenario requiring urgent evaluation and management.

The other patients are not currently in an acute crisis: a post-adrenalectomy patient with Cushing disease isn’t described as having a hypertensive emergency; Addison’s disease in a stable state isn’t acutely dangerous in this moment; and hyperaldosteronism without acute symptoms does not imply an urgent crisis.