Hyperaldosteronism and Pheochromocytoma

Question 1

where in adrenal do aldosteronomas arise?

Answer 1

in zona glomerulosa

Question 2

where is issue in primary hyperaldo?

Answer 2

in adrenal gland

Question 3

what are the two main causes of primary hyperaldo?

Answer 3

unilateral adenoma
and
bilateral adrenal hyperplasia

Question 4

what is another name for primary hyperaldo from unilateral adenoma?

Answer 4

Conns syndrome

Question 5

primary hyperaldo leads to what three ion changes

Answer 5

Na reabsorption in kidney
K+ excretion
H+ excretion

Question 6

what three things do you measure in diagnosis for primary hyperaldo

Answer 6

serum aldo
plasma renin
aldo:renin ration

Question 7

primary hyperaldo has what lab values for serum aldo
plasma renin
aldo:renin ratio?

Answer 7

Plasma aldo increased
renin decreased
ration increased

Question 8

secondary hyperaldo has what lab values for serum aldo
plasma renin
aldo:renin ratio?

Answer 8

increased aldo
increased renin
normal or low ratio

Question 9

what are four possible etiologies of secondary hyperaldo?

Answer 9

renin producing tumor
coarctation of the aorta
fibromuscular dysplasia
renal artery stenosis

Question 10

if you have what seems to be high aldo but low aldo conc and low renin, what are possible causes? what is this called?

Answer 10

called pseudohyperaldo

Congen adrenal hyperplasia, cushings, licorice are possible causes

Question 11

what is confirmation test for primary hyperaldo?

Answer 11

aldosterone suppression test by giving a salt load

Question 12

what should response be to a salt load? what happens in primary hyperalso?

Answer 12

decreased aldosterone…primary hyperaldo does not decrease the aldo in response to increased salt load

Question 13

what is rx for young patient with clear unilateral adrenal mass secreting aldo?

Answer 13

surgery…unilateral adrenalectomy

Question 14

what test can you do to help determine where aldo is coming from in adrenals? like which one or both producing?

Answer 14

adrenal vein sampling

Question 15

if adrenal vein sampling for aldo lateralizes what does this mean?

Answer 15

that aldo increase is mainly from lateralized side and likely a unilateral problem so surgery more likely to help

Question 16

if adrenal vein sampling does not lateralize what does that mean?

Answer 16

patient likely has bilateral adrenal hyperplasia and aldo coming from both sides

Question 17

which adrenal vein is easier to sample from? why?

Answer 17

left suprarenal vein because angle is less severe, right is at 90 degree angle

Question 18

what is rx for aldo producing adenoma?

Answer 18

surgery

Question 19

what is rx for bilateral hyperplasia?

Answer 19

medication

Question 20

name the two drugs to treat aldo excess

Answer 20

spiranolactone and epleronone

Question 21

which of spiranolactone and epleronone is used more, why?

Answer 21

spironolactone…bc cheaper

Question 22

secondary hyperaldo in adults is most commonly due to what?

Answer 22

renal artery stenosis

Question 23

what is rx for renal artery stenosis?

Answer 23

balloon angioplasty or ACE/ARBs

Question 24

what is MEN1?

Answer 24

a genetic neuroendocrine causing tumor

Question 25

what three tumors arise from MEN1 mutations?

Answer 25

primary hyperparathyroid pituitary adenomas pancreatic neuroendocrine tumor

Question 26

what is inheritance of MEN1

Answer 26

AD

Question 27

in addition to parathyroid, pancreas and pituitary, what other endo organ can have issue in MEN1?

Answer 27

adrenal adenomas

Question 28

what happens in MEN 2 type 2A?

Answer 28

medullary thyroid cancer with primary hyperparathyroid | pheochromocytoma

Question 29

what is inheritance of MEN2 type 2A?

Answer 29

AD

Question 30

what happens in MEN2 type 2B?

Answer 30

medullary thyroid cancer, pheochromocytoma

Question 31

what is inheritance of MEN2 type 2b?

Answer 31

AD

Question 32

what is pheochromocytoma a tumor of?

Answer 32

chromaffin cells in adrenal medulla

Question 33

why are pheochromocytomas called the 10% tumor?

Answer 33

10% bilateral 10% outside the adrenal medulla in symp ganglia 10% malignant 30% inherited

Question 34

what are the three main symptoms of pheochromocytoma?

Answer 34

HA diaphoresis palpitations

Question 35

what are two things to measure when worried about pheochromocytoma?

Answer 35

24 hr urine metaneprines and plasma metanephrines

Question 36

are pheochromocytomas always only in adrenal medulla?

Answer 36

no can have tumor in sympathetic ganglia too. called paraganglionoma

Question 37

if worried about paraganglionoma what should you do?

Answer 37

CT/MRI of abdomen called 123 I_MIBG

Question 38

what is fist rx for pheochromocytoma?

Answer 38

surgery

Question 39

describe medical management of pheochromocytoma

Answer 39

alpha block first then beta block with vigorous hydration

Question 40

why do you alpha block before you beta block in pheochromocytoma?

Answer 40

beta adrenergic normal effect on vasculature is to vasodilate so if you block it first then alpha is unopposed in constriction and can have worsening HTN