Wk6 Primary and Secondary Hypertension

Question 1

What are the different classifications of blood pressure?

Answer 1

Normal 120/80
High normal 139/89
Mild hypertension 159/99
Moderate hypertension 179/109
Severe 180/110

Question 2

Primary hypertension

Answer 2

no single cause resulting in elevate BP

• multifactoral
• genetic and evironmental factors (salt, exercise, smoking, alcohol, obesity)

Question 3

What percetage of hypertension is primary hypertension?

Answer 3

85-90%

Question 4

Secondary Hypertension

Answer 4

known cause (potentially curable or specific treatment)

Question 5

What is primary aldosteronism?

Answer 5

aka Conn’s syndrome?

• would have a high aldosterone but low renin
• hyperplasia, adenoma, carcinoma

Question 6

If you have high aldosterone levels and have nothing wrong with your renin system, should you have high or low renin levels?

Answer 6

You should have LOW renin levels.

Question 7

If you have high renin levels, should your aldosterone levels be high or low?

Answer 7

HIGH

Question 8

Hypothalamic-pituitary-adrenal axis

Answer 8

LOOK THIS UP

Question 9

Primary Aldosteronism

Answer 9

• increased incidence with greater screening tests
• adenoma (benign)
• carcinoma
• hyperplasia
• glococorticoid suppressible hyperaldosteronism (GSH)

Question 10

If a patient with hypertension has volume expansion, hypokalaemia, and metabolic alkalosis, what should you be thinking of as the cause?

Answer 10

Primary Aldosteronism

Question 11

Diagnosis of Primary Aldosteronism

Answer 11

• hypertension
• increased aldosterone/renin ratio (remember renin system is normal)
• aldosterone suppression testing (saline infusion, fludrocortisone admintistration)
• genetic testing

Question 12

Treatment of Primary Aldosteronism

Answer 12

• surgery –> remove the gland thats producing too much aldosterone (adrenalectomy)
• targeted antihypertensives – these drugs would directly act on the receptor for aldosterone

Question 13

Spironolactone

Answer 13

act against or bind to aldosterone receptor

Question 14

Aldosterone-producing adenoma

Answer 14

• yellow in color because the lipids are precursors to aldosterone (mineralcorticoid)

Question 15

Cuchings disease

Answer 15

• think glucocorticoid excess –> cortisol excess
• more common in females
• muscle wasting in the legs (causes catabolism)
• ACTH hpersecretion from pituitary –> tumor or hyperplasia
• usually latrogenic (something we did by putting people on corticosteroids)
• autonomous cortisol secretion

Question 16

Hypothalamic-pituitary-adrenal cortex

• normal function
• addisons disease
• cuchings disease
• ectopic ACTH
• ectopic CRH
• adrenal adenoma/carcinoma
• latrogenic cushings sundrome

Answer 16

.

Question 17

Curshing’s questions: predict levels of ACTH and Cortisol in the following cases:

1) lesion in the pituitary
2) lesion in the adrenals
3) lesion was ectopic tumor

Answer 17

1) high ACTH, high cortisol (why?)
2) low ACTH, high cortisol
3) high ACTH, high cortisol

Question 18

Phaeochromocytoma - clinical features

Answer 18

• headaches, sweating, papitations, anxiety
• hypertension (sustained and or paroxysmal)
• hyperglycemia
• increased 24hr urinary catecholamines

Question 19

Congetical Adrenal Hyperplasia

Answer 19

• deficiency of one of the - many enzymes needed to produce aldosterone from cholesterol.
• need to commit to memory from Crush step.