Adrenal 3 (Hyperaldosteronism/Pheochromocytoma)

Question 1

How does Licorice cause excess cortisol?

Answer 1

Inhibits 11-beta-hydroxysteroid dehydrogenase, which normally inactivates cortisol to cortisone

Question 2

What are some causes of Secondary hypertension

Answer 2

Pheochromocytoma
Renal artery stenosis
Primary Hyperaldosteronism (Cushing’s, licorice)

Question 3

Causes of PRIMARY Hyperaldosteronism

Answer 3

Unilateral Adrenal Adenoma (Conn’s syndrome)
Bilateral Adrenal Hyperplasia
Glucocorticoid Remediable Aldosteronism

Question 4

Type of Primary Hyperaldosteronism; AD inheritance; mutation causes aldosterone secretion being controlled by ACTH instead of RAAS

Answer 4

Glucocorticoid Remediable Aldosteronism (GRA)

Question 5

Autonomous production of aldosterone; responsible for ~10% cases of HTN; can be due to Adenoma or Bilateral Adrenal Hyperplasia

Answer 5

Primary Hyperaldosteronism

Question 6

Signs/Symptoms of Primary Hyperaldosteronism

Answer 6

HTN
CHF
Muscle weakness (hypokalemia)
Arrhythmias (hypokalemia)
Metabolic alkalosis

Question 7

Difference between Primary and Secondary Hyperaldosteronism in regards to lab findings

Answer 7

Primary: low renin
Secondary: high renin

Question 8

Tests used to diagnose Primary Hyperaldosteronism

Answer 8

Measure aldosterone and renin levels

Aldosterone suppression testing

Question 9

How can you determine whether or not a patient’s aldosterone excess is unilateral or not (Adenoma vs. bilateral adrenal hyperplasia)?

Answer 9

Adrenal Vein Sampling (AVS)

Question 10

Treatments for Primary Hyperaldosteronism

Answer 10

Adenoma: sugery or meds

Bilateral Hyperplasia: meds

Question 11

Medications for Primary Hyperaldosteronism

Answer 11

Aldosterone-receptor blockers (Spironolactone, Epleronone)

Others (renin inhibitors, ACE inhibitors, ARBs, etc.)

Question 12

Secondary Hyperaldosteronism in adults is most commonly due to…

Answer 12

Renal Artery Stenosis (atherosclerosis)

Question 13

Treatments for Renovascular HTN

Answer 13

Sugery/Balloon Angioplasty (open stenosis)

Drugs (ACE-i, ARBs, etc.) (

Question 14

Tumor of the GI tract; tremendous Serotonin secretion; leads to flushing, diarrhea, abdominal pain, heart failure and bronchoconstriction; diagnose via 5-HIAA (breakdown product of serotonin)

Answer 14

Carcinoid tumor (from neuroendocrine cells)

Question 15

Signs/Symptoms of Carcinoid tumor

Answer 15

Flushing
Diarrhea
Abd. pain
HF
Bronchconstriction

Question 16

Tumor of the Adrenal Medulla; causes excess catecholamine secretion; can cause headache, diaphoresis, palpitations and HTN; can be caused by MEN-2a, VHL and Neurofibromatosis; diagnose via urine/plasma metanephrines (breakdown products of catecholamines)

Answer 16

Pheochromocytoma

Question 17

Classic triad for Pheochromocytoma

Answer 17

Headache
Diaphoresis
Palpitations

Question 18

How can you diagnose Pheochromocytoma?

Answer 18

Urinary or Plasma metanephrines

Question 19

What cancers are MEN-2a associated with

Answer 19

“MPH”

Pheochromocytoma (50%)
Medullary Thyroid cancer
Hyperparathyroidism

Question 20

Treatment for Pheochromocytoma

Answer 20

Surgery
Drugs 
- alpha-blockers FIRST
- then beta-blockers
- Hydration