Adrenal causes of hypertension Flashcards Preview

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Flashcards in Adrenal causes of hypertension Deck (19)
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1
Q

Layers of the adrenal glands

A

Outer - glomerulosa

Middle - fasciculata

Inner - reticularis

2
Q

Primary hyperaldosteronism

A

Zona glomerulosa

  • adenoma
  • hyperplasia
3
Q

Who to screen for primary hyperaldosteronism

A

Hypokalaemia

Resistant hypertension (3 drugs)

Younger people

4
Q

Initial screening fot primary hyperaldosteronism

A

Suppressed renin

Normal/ high aldosterone

5
Q

Confirmatory tests for primary hyperaldosteronism

A

Oral or IV Na+ suppression test

6
Q

Treatment for unilateral adenoma

A

Laprascopic adrenalectomy

Medical treatment (sometimes)

7
Q

Treatment for bilateral hyperplasia

A

Medical treatment (aldosterone antagonist)

  • spironolactone
  • eplerinone
8
Q

Phaeochromocytoma

A

Tumour of the adrenal medulla

9
Q

Products of the adrenal medulla

A

Catecholamines

  • dopamine
  • norepinephrine
  • epinephrine
10
Q

Adrenomedullin

A

Peptide associated with phaeochromocytoma

Gene located on chromosome 11

Positive influence in hypertension, MI, COPD

11
Q

Biological effects of noradrenaline

A

Acts on alpha 1 and 2

Vasoconstriction

  • increased BP
  • pallor

Glycogenolysis

12
Q

Biological effects of adrenaline

A

Vasoconstriction

Vasodilation in muscle

Increased heart rate

Sweating

13
Q

Presentation of phaeochromocytoma

A

Spells

  • headache, sweating
  • pallor, palpitation
  • anxiety

Hypertension

  • permanent
  • intermittent

Family history

14
Q

AD conditions associated with phaechromocytoma

A

Neurofibromatosis type 1

Multiple endocrine neoplasia type 2

Von Hippel- Lindau syndrome

15
Q

Neurofibroma

A

Tumour under the skin

16
Q

Phaeochromocytoma biochemical diagnosis

A

24 hour urine

  • normetanephrines and metanephrines
  • 3 methoxytyromine

Plasma

  • noradrenaline and adrenalin
  • metanephrines
17
Q

Other things that elevate measured catecholamines

A

Obstructive sleep apnoea

Amphetamine like drugs

L-DOPA

Labetalol

18
Q

Management of phaeochromocytoma

A

Alpha blockers

  • phenoxybenzamine
  • doazocin

Beta blockers
- propanolol

Laparoscopic adrenalectomy

19
Q

Post adrenalectomy care

A

Consider genetic testing
- 30% are genetic

Annueal metanephrines

  • 24 hour urine
  • plasma

Additional treatment if malignant
- 10%