Mineralocorticoid excess states Flashcards
What causes primary hyperaldosteronism?
Bilateral cortical nodular hyperplasia - 60% idiopathic
Unilateral adenoma - 35%
- aka Conn syndrome
Adrenal carcinoma - in rare cases
Familial hyperaldosteronism - rare cases with an activating mutation to the enzyme aldosterone synthase
What are the symptoms of hyeraldosteronism?
Excessive aldosterone
Suppressed Plasma Renin Activity, PRA
Increased Aldosterone: Renin ratio
Hypertension
- especially diastolic hypertension
- headaches
only 50% will have hypokalemia
Etiology of primary hyperaldosteronism
Twice as common in women
Occurs ages 30-50
Found in 1-5% of random hypertensive patients
Symptoms of hypokalemia
- Symptoms occur if plasma K+ is < 3.0 mmol/L
- Weak and tired legs
- Fatigue
- Myalgias
- Hypoventilation due to respiratory muscle weakness
- Paralysis
- Nocturia, polyuria, polydipsia
- Flattening of T waves
- Presence of “u” waves
Causes of secondary hypertension?
Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing’s syndrome, Drugs, Diet, excess Erythropoietin, and Endocrine disorder
Aorta
Aortic Regurgitation
Aortic Coarctation
Kidney
Glomerular disease
Renal Artery Stenosis
Polycystic Kidney Disease
Adrenal
Cushing’s and Conn’s
Pheochromocytoma
Thyroid
Hyperthyroidism - isolated systolic hypertension
Hypothyroidism - isolated diastolic from sodium retention
Hyperparathyroidism - hypercalcemia
Drug induced,
oral contraceptive increase angiotensinogen synthesis
cocaine, other rec drugs
Pregnancy
What are the frequency rates of unrecognized, treated and uncontrolled, and treated and well controlled hypertension?
Males • 41% unrecognized • 29% treated, not controlled • 30% well controlled Females • 60% unrecognized • 19% treated, not controlled • 21% well controlled
