Adrenal causes of hypertension

Question 1

what are the 3 distinct zones of the adrenal gland?

Answer 1

zona glomerulosa, zona fasciculata, zona reticularis.

Question 2

what are the causes of hypertension?

Answer 2

Essential
Renal - primary renal disease, renal artery stenosis
Endocrine - adrenal: primary hyperaldosteronism due to adenoma or hyperplasia of the zona glomerulosa.

Question 3

who should be screened if primary hyperaldosteronism is suspected?

Answer 3

hypokalaemia, resistant hypertension (3 drugs), younger people.

Question 4

what are the initial screening tests and confirmatory tests for PA?

Answer 4

initial: suppressed renin. normal/high aldosterone.
confirmatory: oral or IV Na+ suppression test.

Question 5

which tests are used to determine the aetiology of PA i.e. secreting adenoma or bilateral hyperplasia?

Answer 5

adrenal CT scan.
adrenal venous sampling: is aldo secretion unilateral?
metomidate PET CT.

Question 6

what is the treatment for primary hyperaldosteronism?

Answer 6

unilateral adenoma: laparoscopic adrenaloectomy, medical treatment sometimes.
bilateral hyperplasia: aldosterone antagonist - spironolactone, eplerinone.

Question 7

what is pheochromocytoma?

Answer 7

tumour of the adrenal medulla.

Question 8

what are the products of the adrenal medulla?

Answer 8

catecholamines: dopamine, epinephrine, norepinephrine (cortisol converts norepinephrine to epinephrin).

Question 9

what is the presentation of someone with pheochromocytoma?

Answer 9

‘spells’: headache, sweating. pallor, palpitation. anxiety.
hypertension - permanent, intermittent.
family history.

Question 10

which genetic conditions are associated with pheochromocytoma?

Answer 10

neurofibromatosis type 1 (NF1).
multiple endocrine neoplasia type 2 (MEN 2).
Von Hippel-Lindau syndrome.

Question 11

what is the biochemical diagnosis of phaeochromocytoma?

Answer 11

24 hour urine: normetanephrine and metanephrine. 3-methoxytyromine.
plasma: adrenalin and noradrenalin. metanephrine.

Question 12

how is pheochromocytoma managed?

Answer 12

alpha blockers: phenoxybenzamine, doxazosin.
beta blockers: propanolol.
laparoscopic adrenalectomy.

Question 13

What are the biological effects of adrenaline and noradrenaline?

Answer 13

Noradrenalin: 
vasoconstriction - increased BP, pallor
glycogenolysis
Adrenalin:
vasoconstriction
vasodilatation in muscle
increased heart rate
sweating