Endocrine Hypertension

Question 1

What is secondary HT?

Answer 1

When hypertension occurs due to an identifiable underlying cause, it is defined as secondary hypertension (SHT)

Question 2

In which pt should we consider secondary HT?

Answer 2

• Patients diagnosed with hypertension at a young age (especially before the age of 30)
• Patients with hypertension and hypokalemia
• Patients with hypertension and adrenal adenoma
• Resistant hypertension
• Patients whose blood pressure control suddenly deteriorates
• Patients using medications that may cause hypertension (oral contraceptives, decongestants, glucocorticoids, non-steroidal
  anti-inflammatory drugs, immunosuppressive drugs,
• Patients with findings suggestive of sleep apnea
• Patients with severe increases (>30%) in creatinine levels after the use of angiotensin converting enzyme (ACE) inhibitors
  or angiotensin receptor blockers (ARBs)
• Signs suggestive of pheochromocytoma such as sudden high blood pressure, sweating, palpitations,&headaches
• Patients with a family history of kidney disease
• Patients with blood pressure differences between extremities
• Patients with more target organ damage compared to their blood pressure level
• Patients with findings suggestive of Cushing Syndrome such as central obesity, proximal muscle weakness, pink-purple striae

Question 3

**what is the classical triad for diagnosing pheochromocytoma?

Answer 3

Palpations, headache, profuse sweating
+
Hypertension(up to 220/90)

Question 4

What is pheochromocytoma?

Answer 4

Pheochromocytomas and paragangliomas are catecholamine-producing tumors derived from the sympathetic or parasympathetic nervous system.

Question 5

How to diagnose pheochromocytoma?

Answer 5

Lab: Elevated plasma and urinary levels of catecholamines and metanephrines(epinephrine/norepinephrine) form the cornerstone of diagnosis.

Imaging: T2-weighted MRI with gadolinium contrast is optimal for detecting pheochromocytomas and is somewhat better than CT for imaging extraadrenal pheochromocytomas and paragangliomas.

Question 6

** In which patients will we suspect primary hyperaldosteronism?

Answer 6

• Presence of hypokalemia in a hypertension patient
• Severe, resistant or relatively acute hypertension
• Presence of adrenal incidentaloma in a hypertension patient
• Diagnesed HT and < 30 age, without obesity or familial hypertension
• If one of the family members of a hypertension patient developed stroke under the age of 50