Flashcards in Adrenal causes of Hypertension Deck (17)
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1
Zona glomerulosa
Outermost functional section of the adrenal cortex
- Contains closely packed cells
Produces mineralocorticoids---> aldosterone
2
Zona fascicularis
Middle function layer of the adrenal cortex
- Contains clear cells in cords.
Produces glucocorticoids--> Cortisol
3
Zona reticularis
Innermost functional layer of the adrenal cortex
- Contains small, darkly stained cells.
Produces adrenal androgens---> Testosterone
4
Pheochromocytoma
- Defintion
Tumour of the adrenal medulla.
- Excess production of catecholamines= hypertension
5
Pheochromocytoma
- Presentation
Headaches
Sweating
Pallor
Palpitations
Anxiety
Hypertension
Family history
6
Genetic conditions associated with pheochromocytoma
Neurofibromatosis T1 [NF1]
Multiple endocrine neoplasia T2 [MEN 2]
Von Hippel- Lindau syndrome
7
Biochemical diagnosis of phaechromocytoma
24 hr urine
- Normetanephrines [NA metabolite]
- Metanephrines [Adrenaline metabolite]
- Methoxythyromine [metabolite of 5-HT]
Plasma
- NA and ADR
- Metanephrines
8
Other conditions that elevate catecholamines in the urine/ blood [4]
Obstructive sleep apnoea
Amphetamine-like drugs
L-DOPA
Labetalol [antihypertensive]
9
Imagining of phaos
MIBG scan [Meta-iodibenzylguanidine]
10
Medical and surgical management of Phaos
Medical
- Alpha adrenergic blockers: phenoxybenzamine, doxazocin
- Beta blocks: Propranolol
Surgical
- Laparoscopic adrenalectomy
11
Primary hyperaldosteronism
- Defintion
- Presentation
Conn's syndrome
- Excess production of aldosterone due to hyperactive cortex
- Specifically glomerulosa.
Presentation
- Hypertension [increased Na+ absorption= increased fluid absorption]
- Fatigue
- Polyuria
- Flank pain
- Muscular weakness/ pain
12
Primary hyperaldosteronism causes
Bilateral idiopathic adrenal hyperplasia
Adrenal adenoma
Unilateral adrenal hyperplasia
Genetic
13
Individuals at high risk of primary hyperaldosteronism [requiring screening]
Young patients
- Less likely to have hypertension
Hypokalemia
- Indicates increased excretion of K+
Resistant hypertension
- Requiring 3 antihypertensive drugs
14
Diagnostic biochemical tests for primary hyperaldosteronism
Initially
- Renin [will be suppressed, negative feedback from RAS].
- Aldosterone levels- high/normal
- Alkalosis
Confirmatory
- Oral/ IV Na+ solution given---> Levels of Na+ will not drop.
15
Aetiological tests for primary Hyperaldosteronism
Adrenal CT scan
Adrenal venous sampling
Metomidate PET CT
16
Management of primary hyperaldosteronism
If unilateral adrenal adenoma
- Laparoscopic adrenalectomy
Bilateral adrenal hyperplasia
- Aldosterone antagonist: spironolactone, eplerinone.
17
