Adrenal causes of Hypertension Flashcards Preview

203: The endocrine system > Adrenal causes of Hypertension > Flashcards

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

Post adrenalectomy care

Genetic screening
- nearly a third of primary hyperaldosteronism are due to genetics

Annual assessment of metanephrines

Additional treatment if tumour is malignant.