Hypercalcamia + Hypertension Flashcards
What are the features of hypercalcaemia?
- ‘bones, stones, groans and psychic moans’
- corneal calcification
- shortened QT interval on ECG
- hypertension
What are causes of palmar xanthoma?
- remnant hyperlipidaemia
- may less commonly be seen in familial hypercholesterolaemia
What is eruptive xanthoma?
High triglyceride levels and present as multiple red/yellow vesicles on the extensor surfaces (e.g. elbows, knees)
What are causes of eruptive xanthoma?
- familial hypertriglyceridaemia
- lipoprotein lipase deficiency
What are causes of tendon xanthoma, tuberous xanthoma and xanthelasma?
- familial hypercholesterolaemia
- remnant hyperlipidaemia
- xanthelasma are also seen w/o lipid abnormalities
What is the management of xanthelasma?
- surgical excision
- topical trichloroacetic acid
- laser therapy
- electrodesiccation
What is classified as hypertension?
- a clinic reading persistently above >= 140/90 mmHg
- a 24 hour blood pressure average reading >= 135/85 mmHg
What is primary hypertension?
- 90-95% have primary, or essential, hypertension
- No single disease causing the rise in blood pressure but rather a series of complex physiological changes which occur as we get older
What is secondary hypertension?
Caused by a wide variety of endocrine, renal and other causes
What are renal causes of hypertension?
- Glomerulonephritis
- Chronic pyelonephritis
- Adult polycystic kidney disease
- Renal artery stenosis
What are endocrine causes of hypertension?
- Primary hyperaldosteronism
- Phaeochromocytoma
- Cushing’s syndrome
- Liddle’s syndrome
- Congenital adrenal hyperplasia (11-beta hydroxylase deficiency)
- Acromegaly
What are other causes of hypertension?
- Glucocorticoids
- NSAIDs
- Pregnancy
- Coarctation of the aorta
- Combined oral contraceptive pill
What are symptoms of hypertension?
Hypertension doesn’t cause symptoms unless very high, for example > 200/120 mmHg. If very raised patients may experience:
- headaches
- visual disturbance
- seizures
What else should be investigated in newly diagnosed hypertension?
- Fundoscopy: to check for hypertensive retinopathy
- Urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
- ECG: to check for left ventricular hypertrophy or ischaemic heart disease
What other investigations (except 24 hour monitoring) should be carried out after diagnosis of hypertension?
- Urea and electrolytes: check for renal disease, either as a cause or consequence of hypertension
- HbA1c: check for co-existing diabetes mellitus, another important risk factor for cardiovascular disease
- Lipids: check for hyperlipidaemia, again another important risk factor for cardiovascular disease
- ECG
- Urine dipstick
What is the management of hypertension according to NICE?
