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Endocrine > Suprarenala HTA secundara > Flashcards

Suprarenala HTA secundara Flashcards

1
Q

Cauze de HTA secundara dat de exces hormonal:

A
  1. Exces de glucocorticoizi ± mineralocorticoizi androgeni SR (Sd. Cushing) NU BOALA CUSHING la mineral
  2. Exces de mineralocorticoizi (Sd. Conn)
  3. Exces de catecolamine (Feocromocitom)
  4. Exces de GH (Acromegalie)
  5. Exces de PTH (Hiperparatiroidism)
  6. Exces de hormoni tiroidieni (Hipertiroidism - numai TA sistolica)
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2
Q

Cauze de HTA secundara de sinteza (enzime/Rec)

A
  1. sinteza crescuta DOC (deficit de 11B-hidroxilaza si 17 Alpha hidroxilaza)
  2. sinteza crescuta angiotensinogen (tratament ACO)
  3. stimulare R aldosteron (11 β HSD depasita)
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3
Q

Care sunt inhibitor de elib reninei?

A
  1. AINS
  2. B-bloc
  3. ciclosporina
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4
Q

Ce inhiba enzima de conversie?

A

IECA

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5
Q

Ce medicament inhib receptorul de Aldosteron?

A

Spironolactona (Risc de Hiperpotasemie)

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6
Q

Care sunt cauzele de Hiperaldosteronismul primar?

A
  1. Adenom secretant de aldosteron (sindrom Conn)
  2. Hiperplazie adrenala primara
  3. Carcinom suprarenalian
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7
Q

Ce particularitati avem in caz de exces mineralocorticoizi?

A
  1. Simptomatologie neuromusculara (slabiciune musculara, crampe, paralizie periodica), astenie,
    parestezii.
    2.HTA moderata – severa, fara edeme
  2. Poliurie, nicturie
  3. Afectarea organelor tinta – HVS disproportionata fata de nivelul TA, reversibila
  4. HTA cu hipopotasemie, in lipsa tratamentului diuretic
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8
Q

Care sunt indicatiile pt Screening in hiperaldosteronism?

A
  1. HTA rezistenta la tratament
  2. HTA si hipoK spontana sau indusa de diuretice
  3. HTA cu incidentalom adrenal
  4. HTA si istoric familial de instalare precoce a HTA sau AVC la varsta tanara (< 40 de ani)
  5. Evaluarea tuturor rudelor de gradul I cu HTA
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9
Q

Indicatii paraclinice uzuale arata in hiperaldosteronism?

A
  1. Hipopotasemie (< 3,5 mEq/L), in lipsa tratamentului diuretic, aport normal/crescut de sare (! Nu e obligatorie)
  2. Hiperkaliurie
  3. Alcaloza hipercloremica
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10
Q

Cand se efectuaza testele de Screening in hiperaldosteronism?

A

a. Corectia hipopotasemiei
b. Liberalizarea aportului de Na
c. Oprirea spironolactonei si a diureticelor ce influenteaza nivelul K cu cel putin 4 saptamani

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11
Q

Un pac cu Hiperaldosteronism ce face corpul fiziologic?

A
  1. Retine Na –> Hipernatremie

2. Excreta Potasium —> Hipopotasemie

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12
Q

Care sunt testele de Screening in hiperaldosteronism?

A
  1. ARP (<1 ng/ml/h) –> Renina scz
  2. Aldosteron plasmatic (clino, aport Na normal sau crescut)>15 ng/ml —> Aldosteron mare
  3. Raport AP/ ARP > 25 (dupa 2 ore ortostatism)
    ===> Aldo mare / Renina mica
    Rezulta: Raportul intre cele 2 fiind mare!
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13
Q

Care sunt testele de confirmare a hiperaldosteronism?

A
  1. Infuzie salina (2000 ml SF in perfuzie si recoltare baza si la 2h a aldosteronului) - AP daca aldosteronul >10ng/dl
  2. Test de provocare la captopril: 25-50mg captopril, dozare aldosteron, ARP 0-60-120 min.
    - –> Aldosteron nesupresat si ARP < 1ng/ml
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14
Q

Teste pt localizarea cauzei in hiperaldosteronism:

A
  1. CT, RMN abdominal
    2.Cateterizare vene adrenale: pentru diagnosticul diferential intre un adenoma suprarenalian (unilateral) si hiperplazia adrenal bilaterala
    3.
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15
Q

Diagnostic diferential la Hiperaldosteronism:

A
  1. Hiperaldosteronismul secundar (clinica: ciroza, IC, HTA reno-vasculara; ARP crescuta)

Alte cauze:

  1. Deficit de 17 alfa hidroxilaza, 11 beta hidroxilaza
  2. Excesul aparent de mineralocorticoizi (deficit de 11 beta HSD)
  3. Sindromul Liddle (mutatie activatoare a canalului de Na de la nivelul TC)
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16
Q

Care este tt chirurgical in hiperaldosteronismului primar?

A

Suprarenalectomie/adnomectomie unilaterala in sindromul Conn

17
Q

Care este tt Medicamentos in hiperaldosteronismului primar?

A
  1. Spironolactona 200-400 mg/zi – ginecomastie, tulburari de ciclu menstrual
  2. Amilorid 20-40mg/zi
  3. Dieta hiposodata si suplimente de potasiu
18
Q

Care este o cauza de HTA prin exces de

catecolamine?

A

Feocromocitomul

19
Q

Ce este Feocromocitomul?

A

Tumora MSR ce secreta catecolamine

20
Q

Care sunt semnele clinice in Feocromocitomul?

A

5P:

  1. Pressure (HTA) - 90%
  2. Pain (Cefalee) - 80%
  3. Perspiration - 71%
  4. Palpitatii - 64%
  5. Paloare - 42%
21
Q

Care este triada clasica in Feocromocitomul?

A

• Cefalee, transpiratii, palpitatii

22
Q

Criza tipic de Feocromocitom consta in?

A
  1. Durata 10-60 minute
  2. Frecventa: zilnic - lunar

Spontane/precipitate de:
❖Proceduri diagnostice (substanta de contrast)
❖Medicamente (opioide, B-blocante, anestezice, histamina, ACTH, glucagon, metoclopramid)
❖Efort fizic intens, miscari ce cresc presiunea
intraabdominala
❖Mictiune (paraganglioame vezicale)

23
Q

Tumorile extraadrenale ale tesutului cromafin se numesc?

A

paraganglioame

24
Q

Indicatii pt screening in Feocromocitom?

A
  • HTA cu manifestari paroxistice sugestive (triada cefalee- palpitatii-diaforeza)
  • HTA refractara
  • HTA labila
  • Raspuns presor sever sau hipotensiune inexplicabila indusa de anestezie, chirurgie
  • Masa SR descoperita intamplator
25
Q

Cand se recomanda testarea genetica in cazului unui Feocromocitom?

A

a. istoric familial
b. debut sub 50 ani
c. feo malign
d. afectiuni associate ce sugereaza un sindrom

26
Q

Care este tt preop in feocromocitom?

A
  1. Blocante ale canalelor de calciu
  2. Blocante alfa-adrenergice (fenoxibenzamina, prazosin)
  3. Inhibitori ai enzimei de conversie
  4. ! Nu se administreaza beta-blocante selective singure
27
Q

Care este tt de electie in Feocromocitomul?

A

Interventie chirurgicala de excizie a tumorii

28
Q

Renina fiind stimulata de?

A
  1. hTA

2. Hiponatremie

Endocrine (12 decks)

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