Endocrine - Hypertension

Front 1

Hypertension

-signs that it may be an endocrine disorder

Back 1

1. severe and resistant HTN
2. new onset HTN in the young (<20) or old (>55)
3. HTN with spontaneous hypokalemia (primary aldosterone)
4. Episodic HTN with sweating, tachycardia, headaches (pheochromocytoma)

Front 2

Renal Vascular HTN

-definition
-major causes (2)

Back 2

-most common cause of secondary HTN

-obstruction of the main renal artery or segmental branches (>90% stenosis). Hypoperfusion activates the renin-angiotensin system

1. Atherosclerotic plaques (63%)
2. Fibromuscular dysplasia (32%) - women <30 yrs

Front 3

Renal Vascular HTN

-clinical features (3)
-best distinguishing physical finding

Back 3

1. Abrupt onset of severe HTN in the young (<20) or old (>55)
2. HTN refractory to triple-drug therapy
3. Malignant HTN in caucasian

-upper flank abdominal bruit

Front 4

Renal Vascular HTN

-labs/diagnosis - where do you find athersclerotic lesions vs. fibromuscular disease

Back 4

-in unilateral stenosis, electrolytes, renal function tests, urinalysis, plasma renin are all normal - other kidney is compensating

-angiography is the gold standard - find atherosclerotic lesions in the proximal segment - find fibromuscular disease in the distal segment

Front 5

Renal Vascular HTN

-treatment

Back 5

Want to control blood pressre and preserve renal function

-ACE and aldosterone receptor antagonist blockade
-Angioplasty
-Surgery

Front 6

Primary Aldosteronism

-physical exam findings
-lab findings

Back 6

-Similar to essential HTN with lack of peripheral edema and muscle weakness if potassium is below 2.5

-low serum potassium, metabolic alkalosis

Front 7

Primary Aldosteronism

-pathophysiology

Back 7

Increased aldosterone leads to retention of sodium and loss of potassium - results in increased intravascular volume in a hypokalemic state

Front 8

Primary Aldosteronism

-screening test
-diagnostic test

Back 8

-plasma aldosterone conc / plasma renin activity ratio (PAC/PRA)

-PAC/PRA > 25 is an indicator of the condition

-diagnostic test is oral or i.v. salt loading to see if aldosterone levels respond normally (should be surpressed after 3 days of salt loading)

Front 9

Primary Aldosteronism

-treatment

Back 9

control BP and block aldosterone effect with mineralocorticoid receptor blocker:

-spironolactone
-eplerenone

Front 10

Pheochromocytoma

-definition

Back 10

catechcholamine producing tumor arising from chromaffin cells of neural crest leading to hyper-adrengic state

Front 11

Pheochromocytoma

-triad of symptoms

Back 11

1. Headache
2. Sweating
3. Palpitations

Front 12

Pheochromocytoma

-screening tests for high risk and low risk patients

Back 12

High risk
-plasma metanephrines (high sensitivity)

Low risk
-urinary fractional metanephrine (high specificity)

Front 13

Pheochromocytoma

-treatment

Back 13

Surgery
-pre-op alpha and beta-blockers

recurrance of sporadic tumors is fairly common (15%)