4. Adrenal Causes of Hypertension

Question 1

adrenal anatomy

Answer 1

2 triangular shaped organs
suprarenal
composed of outer cortex and inner medulla

Question 2

layers of adrenal cortex

Answer 2

zona glomerulosa
zona fasciculata
zona reticularis

Question 3

adrenal causes of hypertension

Answer 3

primary hyperaldosteronism
pheochromocytoma
congenital adrenal hyperplasia

Question 4

primary hyperaldosteronism

Answer 4

Conn’s syndrome
excess secretion of aldosterone, resulting in renin suppression
caused (usually) by adrenal adenoma/hyperplasia

Question 5

testing for primary hyperaldosteronism

Answer 5

renin, Na+ suppression test 
for specific aetiology (secreting adenoma, bilateral hyperplasia) 
adrenal CT scan
adrenal venous sampling 
metomidate PET CT

Question 6

primary hyperaldosteronism treatment

Answer 6

unilateral adenoma - laparoscopic adrenalectomy, medical treatment
bilateral hyperplasia - medical treatment (aldosterone antagonists e.g. spironolactone)

Question 7

pheochromocytoma

Answer 7

tumour of adrenal medulla

20% diagnosed in the mortuary

Question 8

adrenal medulla

Answer 8

modified post-ganglionic nerve cells innervated by preganglionic nerves
products = catecholamines (dopamine, noradrenaline, adrenaline)

Question 9

effects of noradrenaline

Answer 9

vasoconstriction (increased BP, pallor)

glycogenolysis

Question 10

effects of adrenaline

Answer 10

vasoconstriction
vasodilation in muscle
increased heart rate
sweating

Question 11

pheochromocytoma presentation

Answer 11

‘spells’ - headache, sweating, pallor, palpitation, anxiety
hypertension - permanent, intermittent
family history

Question 12

genetic conditions associated with pheochromocytoma

Answer 12

neurofibromatosis type 1 (NF1)
multiple endocrine neoplasia type 2 (MEN2)
Von Hippel-Lindau syndrome

Question 13

pheochromocytoma biochemical diagnosis

Answer 13

24 hour urine: normeteanephrines and metanephrines
plasma:
noradrenaline and adrenaline
metanephrines

Question 14

phaechromocytoma management

Answer 14

alpha blockers
beta blockers
laparoscopic adrenalectomy

Question 15

post adrenalectomy care

Answer 15

consider genetic testing (30%)
annual metanephrines
additional treatment if malignant