Hyperaldosteronism

Question 1

Treatment protocol for pheochromocytoma

Answer 1

1. Alpha blockade (Phenoxybenzamine)
2. Beta blockade to treat Alpha blockade-related tachycardia
3. Hydration
4. Surgical resection adrenlalectomy

Question 2

presenting symptoms Pheochromocytomas

Answer 2

HTN

headaches

Diaphoresis

palpitation

orothstaic changes

Question 3

renin levels in primary, secondary hyperaldosteronism

Answer 3

primary - suppressed

secondary- increased

Question 3

Apparent mineral corticoid excess

pathophys

presentation

Answer 3

impaired 110beta hydroyxsteroid dehydrogenase-2 (11-HSD2)

(deactivates cortisol to cortisone in the kindey, which lacks strong mineral corticoid activity (returned via 11-HSD1) high relative cortisone concentration negates aldosterone regulation of mineralcorticoid receptor

presentation: HTN, hypokalemia, metaboic alkalosis

low renin activity

low aldosterone

normal cortisol

Question 4

screening test for suspected primary hyperaldosterims

Answer 4

plasma aldosterone:renin activity ratio

increased ratio indicates primary hyperaldosteronism (aldosterone increased, renin suppressed) (normal ratio is

Question 4

best imaging modality to locate biochemically confirmed pheochromocytomas

Answer 4

CY scan of abdomen/adrenal glands

(somatostaing receptor scannning with labeled octreotide if not located)

Question 5

Liddle syndrome pathophys

Answer 5

mutations in amiloride sensitive epithelial channel > enahnced sodium reabsorption, K wasting, HTN, hypokalemia

low renin and aldosterone levels

Question 6

enzyme of adrenals that converts NE to Epi

implication of this location?

Answer 6

PNMT

adrenal locations allows Pheochromcytomas to secrete NE and Epi, while Paraganglionomas secrete NE

Question 7

mineral corticoid antagonists

therapeutic action

Answer 7

spironolactane, eplerenone

bloack aldosterone action > reduce soidum and water retention

Question 9

ACE inhibitor impact on renin

Answer 9

increases activity and concentration

Question 10

consider primary hyperaldosteronism for

Answer 10

HTN and hypokalemia

resisten HTN

adrenal incentalmoma and HTN

young HTN (

severe HTN

Question 11

Pheocromocytoma vs Pragangliomas morphology and secretions

Answer 11

Pheo - tumors of chromaffin cells of adrenal medulla. Secrete Epi and NE

paragangliomas - tumors of extra-adrenal ganglia of the sympathetic nervous system. Secrete predominantly NE

Question 13

in primary hyperaldosteronism

impact on renin production

Answer 13

negative feedback decreases renin production (which leads to decreased angiotensin)

Question 14

screening for pheochromocytomas

Answer 14

Plasma free metanephrines and urinary catecholamines

Question 15

etiology AME

Answer 15

glycyrrhizic acid - licorice+tobaccos - decreased 11-HSD2

autosomal recessive

Question 16

angiotensin II increases BP via

Answer 16

vasoconstriction

increased aldosterone release from adrenal cortex

Question 16

alpha agonist

beta 2 agonist

Answer 16

Phenylephrine

albuterol

Question 18

treatment, liddle syndrome

Answer 18

Amiloride, traimterene (k sparing diuretics)

mineralcorticoid receptor antagonists ineffective

Question 19

treatment in cases of bilateral hyperaldosteronism

Answer 19

mineralcorticoid receptor antagonists

spironolactone + eplerenone

Question 20

determine if primary hyperaldosteronism is unilateral or bilateral adrenal source via

Answer 20

adrenal CT

adrenal vein sampling (high levels one side, unaffected should be lower)

Question 21

direct renin inhibiotor, decreases activity (not concentration)

Answer 21

aliskerin

Question 22

ARBs

Answer 22

losartan

cadesartan

irbesartan

Question 23

clinical presentation hyperaldosteronism

Answer 23

HTN

hypokalemia