Endocrine hypertension

Question 1

What are the endocrine causes of hypertension?

Answer 1

Low Renin, High Aldosterone, HypoK
1) Primary Hyperaldosteronism

Causes of High Renin High Aldosterone, HypoK

1) Pheochromocytoma
2) Renin producing tumor
3) Renal A stenosis

Causes of Low Renin Low Aldosterone – indicates Pseudohyperaldosteronism (if also have HypoK)

1) Liddle’s Syndrome – mutation of the Na channel 🡪 causing excessive water and salt retention; however NO HYPOK
2) Liquorice; HAVE HYPOK 🡪 Pseudohypoaldosteornism
3) Cushing’s; HAVE HYPOK 🡪 Pseudohypoaldosteornism

Hyperthyroid

Acromegaly

Question 2

What are the drug causes of hypertension?

Answer 2

2nd generation antipsychotics – ask patient if on any MOOD medicines?

OCPs

NSAIDs

Sympathomimetics

Glucocorticoids

Cocaine

TCAs

Question 3

What are the renal causes of hypertension?

Answer 3

1) Renal artery stenosis
2) Polycystic Kidney Disease
3) Nephritic syndrome, RPGN
4) Nephrotic syndrome
5) ESRF & CLD
6) Calculi
7) SLE
8) DM

Question 4

What are the signs to look out for in hyperthyroidism?

Answer 4

tremor, look for thyroid eye signs, opthalmoplegia, goitre

Question 5

What are the symptoms of pheochromocytoma?

Answer 5

flushing, diaphoresis, postural hypotension (due to the excessive vasoconstriction

Question 6

What are the investigations performed for pheochromocytoma?

Answer 6

Check 24hr urine catecholamine

High Renin High Aldosterone

• Catecholamines leads to renal A vasoC despite overall HyperTN
• Hence Pheochromocytoma will also have HypoK (due to RAAS)

Question 7

What are the investigation findings of primary hyperaldosteronism?

Answer 7

Oliguria is hard to elucidate

HypoK can cause muscle weakness, QTc prolongation 🡪 torsade’s de pointes (also cannot ask for Hx)

Low Renin, High Aldo, HypoK

Question 8

What are the symptoms of acromegaly?

Answer 8

• frontal prominence
• large nose
• overbite, thick lips, dental splaying, macroglossia
• bitemporal hemianopia, headaches
• spade like hands, doughy consistence, carpal tunnel syndrome

Question 9

What are the clinical features of OSA?

Answer 9

Elucidate in Hx

• Anyone in family complain you have been snoring?
• Anyone in the family say you wake up gasping for air?
• Day time tiredness? do you fall asleep during driving?

Obesity: a Risk Factpr

Will have erectile dysfunction

• How often do you shave? (reduced testosterone = reduced hair growth)
• Do you feel there is decreased frequency of shaving?
• Do you feel like you have lost interest in opposite sex
• In the last 1 week how many times do you NOT have morning erections in the morning?

Question 10

What are the investigations of OSA?

Answer 10

Do a sleep study! – to look for desaturation! Expensive hence do questionnaire first to see if suggestive

Or do an ABSWORTHS sleepiness scale – simple questionnaire

Or do a STOPBANG questionnaire

Question 11

What is the management of OSA?

Answer 11

• Patient education!
• Multidisciplinary approach: refer/involve smoking cessation, physio etc
• Lifestyle changes: lose weight, refer to physio and dietician
• Medical therapy: CPAP
• Surgical therapy if necessary