OnlineMedEd: Intern Content - "Secondary Hypertension"

Question 1

Review the mnemonic for secondary HTN.

Answer 1

HHHARPCO
•Hypercalcemia
•Hyperthyroidism
•Hyperaldosteronism
•Aortic coarctation
•Renal vasculature abnormalities
•Pheochromocytoma
•Cushing's
•OSA

Question 2

Describe the history associated with each of the causes of secondary HTN.

Answer 2

• Hypercalcemia: bones, stones, groans, moans
• Hyperthyroidism: heat intolerance, diarrhea, weight loss
• Hyperaldosteronism:
• Aortic coarctation: leg claudication or hypotension
• Renal vasculature abnormalities: vasculopath
• Pheochromocytoma: paroxysms of palpitations, perspiration, pain in the head, and pressure elevations
• Cushing’s: difficulty with acne, obesity, diabetes; someone taking steroids
• OSA: daytime somnolence, wakes spouse

Question 3

Describe the physical exam associated with each of the causes of secondary HTN.

Answer 3

• Hypercalcemia: nothing
• Hyperthyroidism: exophthalmos, pretibial goiter
• Hyperaldosteronism: nothing
• Aortic coarctation: warm UE, cold LE, ABI < 0.8
• Renal vasculature abnormalities: abdominal bruit
• Pheochromocytoma
• Cushing’s: abdominal striae, buffalo hump, acne, hirsutism, moon facies, centripetal obesity
• OSA: obesity

Question 4

Review the tests you’d do for each etiology of 2ºHTN.

Answer 4

• Hypercalcemia: serum Ca
• Hyperthyroidism: TSH
• Hyperaldosteronism: aldosterone:renin ratio
• Aortic coarctation: CXR (rib notching)
• Renal vasculature abnormalities: aldosterone:renin ratio
• Pheochromocytoma: serum metanephrines, urinary metanephrines
• Cushing’s: cortisol
• OSA: knock ox or polysomnography

Question 5

An aldosterone:renin ratio less than 10 is suggestive of ____________.

Answer 5

renovascular causes of HTN