Secondary hypertension Flashcards

1
Q

Aldosterone

  • Secretion
  • Regulation
A

Mineralococorticoid released from adrenal gland cortex (glomerulosa)

Regulation
- Secretion is stimulated by ACTH from anterior pituitary

Stimulators

  • low Na+ (most potent)
  • Increased Angiotensin II, III
  • Increased K+ (low Na+)
  • Acidosis
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2
Q

Aldosterone function

A

Stimulates reabsorption of Na+, and thus water in kidneys

  • Acts on mineralocorticoid receptors in distal/ collecting duct.
  • Upregulates Na/K pump.

Stimulates secretion of K+ into urine.

Stimulates Na+ and water reabsorption from the gut, salivary and sweat glands

Stimulates secretion of H+ via the H+/ATPase in the intercalated cells of the cortical collecting tubules

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3
Q

Primary hyperaldosteronism

  • Definition
  • Causes
A

Excess production of aldosterone from the adrenal glands, causing hypernatraemia and low renin.

Causes

  • Bilateral adrenal hyperplasia (most common)
  • Adrenocortical adenoma (Conn’s syndrome)
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4
Q

Signs and symptoms of primary hyperaldosteronism

A

Hypernatraemia, hypokalaemia

Hypertension

Polyuria

Alkalosis

Neuromuscular

  • Weakness
  • Spasms
  • parensthesia
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5
Q

primary hyperaldosteronism investigations

A

Bloods

  • HyperNa+
  • HypoK+
  • HypoCa
  • Aldosterone: renin ratio= high (>70)

ECG (signs of HypoK)

  • Flat T waves
  • U waves
  • Depressed T waves
  • Prolonged PR, QT
  • Toursards de pointes

Imaging
- Adrenal CT/ MRI for adenoma/ hyperplasia.

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6
Q

Primary hyperaldosteronism treatment

A

Conn’s
- laparascopic adrenelectomy

Hyperplasia
- Spironolactone/ eplenerone or amiloride (Aldosterone antagonist)

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7
Q

Secondary aldosteronism

A

High renin, leading to increased aldosterone.

Causes

  • Diuretics
  • CCF
  • Liver failure
  • Nephrotic syndrome

Sign
- normal Aldosterone:renin ratio

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8
Q

Bartter’s syndrome

A

Autosomal recessive condition
- Salt reabsorption in loop of henle is blocked leading to salt wasting

Presentation

  • Hypokalaemia (due to activation of RAS)
  • Metabolic alkalosis

treatment

  • K+ replacement
  • NSAIDs
  • Aldosterone inhibitors
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9
Q

Phaeochromocytoma

  • Definition
  • Associations
A

Tumour causing excess production of adrenaline and other catecholamines.
- Tumour mainly in adrenal medulla and usually benign

Associations

  • MEN
  • Genetic
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10
Q

Phaeochromocytoma

- Signs and symptoms

A

Episodic symptoms

  • Chest tightness
  • Palpitations, sweatinh
  • Paraesthesia
  • Hypertension
  • Anxiety
  • Pallor
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11
Q

Phaeochromocytoma

- Treatment

A

Surgical

BP control pre-op
- Alpha-blocker (phenoxybenzamine) then beta-blockers

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12
Q

Phaeochromocytoma

- Investigations

A

24 hr urine screen for

  • catecholamines
  • Metadrenaline/ normetadrenalines
  • Creatinine

Total/ free serum metadrenaline/ normetanephrines

Plasma cathecholamines

Clonidine suppression

Imaging

  • MIBG scan
  • CT/MRI abdo
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