Adrenal Hypertension Flashcards
Phaechromocytoma?
Tumour of adrenal medulla, chromaffin cells
Pharmacology drugs for aldosterone pathway?
Renin inhibitors, ace inhibitors, aldosterone antagonists, a2 receptor blockers
Who to screen for conn’s syndrome?
Hypokalaemia, resistant hypertension need 4 drugs, younger people
Conns tests?
Initial screening- low renin high aldosterone
Confirmatory- oral/Iv na suppression test- in normal people their aldosterone levels will decrease.
Why do adrenal venous sampling?
To assess whether autonomous hormone production is unilateral or bilateral
Scan to lateralise aldosterone secretion?
Metomidate PET CT
How to treat unilateral adenoma?
Laparoscopic adrenalectomy
Bilateral hyperplasia treatment?
Aldosterone antagonists: spironolactone, eplerinone
Effect of noradrenalin?
Alpha 1 and 2
Vasoconstriction, so high bp, pallor, glycogenolysis
Role of adrenaline?
Alpha 1, beta 1 and 2
Vasoconstriction, increased heart rate, sweating, vasodilation in muscle
Presentation of phaechromocytoma
A?
Spells; headaches, sweating, pallor, palpitation and anxiety
Hypertension, permanent or intermittent.
Family history
Associated conditions with phaechromocytoma?
- Neurofibromatosis type 1- tumours growing along nerves
- Multiple endocrine neoplasia type 2
- Von hippel- Lindau syndrome- formation of tumours and cysts around body
Axillary freckling?
Neurofibromatosis type 1 - dark spots in armpits due to melanin deposition
Biochemical diagnosis of phaechromocytoma?
24 hour urine: normetanephrines and methanephrine’s elevated x4 3 methoxytyromine (metabolite of dopamine)
Plasma high noradrenaline and adrenaline
What else can cause high levels of catecholamines?
Obstructive sleep apnoea
Amphetamine like drugs
Ldopa
Labetalol (inhibits clearnace of adrenaline)
Urine dopamine doesnt come from adrenal medulla so measure urine methoxytyramine
Phaechromocytoma management?
Alpha blockers: phenoxybenzamine, doxazocin
Beta blockers, propranolol
Laparoscopic adrenalectomy
What percentage are genetic?
30%
Also check annually for metanephrines
Adrenal causes of hypertension?
Hyperaldosteronism- zona glomerulosa (adenoma, hyperplasia, genetic cause)
Phaechromocytoma
Congenital adrenal hyperplasia
How does glycyrrhetinic acid cause hypertension?
It inhibits renal 11-beta hydroxysteroid dehydrogenase, which allows cortisol to stimulate mineralocorticoid receptors.
What percent of phaechromocytomas are diagnosed iin mortuary?
20
In which condition do you get cafe au lait marks?
Neurofibromatosis type 1
Multiple endocrine neoplasia type 2?
3 primary cancers: medullary thyroid, parathyroid tumour and phaechromocytoma
What do you find in von-hippel landau?
Retinal hamangioglioblastoma (tumour due to growth of leaky irregular blood cells)
Cerebellar hameangioglioblastoma
When would you do an MIBG scan?
Known or suspected neuroectodermally derived tumour
