Endocrine hypertension Flashcards
Know the conditions associated with hypertension
Linked with heart attacks, strokes, renal failure and heart failure.
Define normal blood pressure and elevated blood pressure
Normal is <85. 140/90 is the cutoff b/w “good” and “high”. Use the highest to classify. Insert table
Identify the most common cause of hypertension
Cardiovascular disease (artherosclerosis or arterial hypertrophy)
List the Endocrine causes of hypertension:
- Hyperaldosteronism, 2. Pheochromocytoma, 3. Cushing’s syndrome, 4. Syndromes of Apparent Mineralocorticoid Excess, 5. Hyperthyroidism, 6. Glucocorticoid-Remediable Hyperaldosteronism, 7. Renin-Secreting Tumors, 8. Defects in Adrenal Steroidogenesis (11B-hydroxylase deficiency, 17A-hydroxylase deficiency
Couple tips on measuring blood pressure
Stress, pain, anxiety will raise it. Proper position (support, feet on floor). Pt not talking. White coat effect is a weird problem. BPTru = popular automated machine.
HTN diagnosis algorithm table.
Add table.
General mechanisms that can cause HTN
Excess hormones such as renin/angiotensin II; excess calcium entry into vascular smooth muscle; increased sympathetic outflow; increased vascular volume; increased vasoconstrictor substances / decreased vasodilator substances; abnormal response to normal constrictor / dilator signals; endothelial dysfunction or just as a manifestation of atherosclerosis
Myths around BP (these are the correct statement)
Salt will only increase BP if you are destined to have HTN. Chronic stress doesn’t increase it. Coffee and smoking do not, only for 30min, then go down.
Hyperaldosteronism and hypertension
.5% of all HTN, most common of endocrine. Causes: 90% Aldosterone-producing adenoma in adrenal (not often seen on CT); Bilateral Adrenal Hyperplasia; Unilateral Adrenal Hyperplasia - may be prior to bilateral adrenal hyperplasia; Glucocorticoid-remediable aldosteronism (chimera of 11βha synthetase gene) - produces aldosterone outside the zona glomerulosa
Know the criteria to diagnose hyperaldosteronism
Low serum K+ (may be as high as 3.8). Next, renin - suppressed or very low; REMEMBER: renovascular hypertension can cause secondary hyperaldosteronism, sometimes sleep apnea can mimic. Next - increased aldosterone - 24 hr urine aldosterone (while on >120mmol Na diet); >49 can be abnormal; or serum measurement >440 pmol/l. Serum aldosterone: active renin >140 is abnormal
What to do to differentiate adrenal tumor/hyperplasia (bilateral or unilateral)
Measure from both sides using vein through femoral artery to see if one side is higher than the other. Difficult to perform. Or use NP-59 - binds to choloesterol R in adrenal cortex.
Cushing’s syndrome and hypertension
Usually obvious. They have cushing’s, and they have high blood pressure.
Pheochromocytoma and hypertension
Tumor of sympathetic ganglia. 10% familial, extradrenal, bilateral and malignant. Diagnose with high metanephrines (metabolites of catecholamines)
List the classic symptoms or “triad” suggestive of pheochromoctyoma
Top 3 are Headache, sweating, palpitations; also, pallor, anxiety, nausea, weight loss, tremor.
Determine the best screening test for pheochromocytoma
Take a good history (get the big 3), Paroxysmal and/or severe sustained HTN despite usual therapy; HTN and symptoms suggestive of catecholamine excess (two or more of headaches, palpitations, sweating, etc); HTN triggered by ß-blockers, monoamine oxidase inhibitors, micturition, or changes in abdominal pressure; Incidentally discovered adrenal mass; Multiple endocrine neoplasia (MEN) 2A or 2B, von Recklinghausen’s neurofibromatosis (elephant man), or vHL disease.
