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Flashcards in Endocrine hypertension Deck (20)
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1
Q

Know the conditions associated with hypertension

A

Linked with heart attacks, strokes, renal failure and heart failure.

2
Q

Define normal blood pressure and elevated blood pressure

A

Normal is <85. 140/90 is the cutoff b/w “good” and “high”. Use the highest to classify. Insert table

3
Q

Identify the most common cause of hypertension

A

Cardiovascular disease (artherosclerosis or arterial hypertrophy)

4
Q

List the Endocrine causes of hypertension:

A
  1. Hyperaldosteronism, 2. Pheochromocytoma, 3. Cushing’s syndrome, 4. Syndromes of Apparent Mineralocorticoid Excess, 5. Hyperthyroidism, 6. Glucocorticoid-Remediable Hyperaldosteronism, 7. Renin-Secreting Tumors, 8. Defects in Adrenal Steroidogenesis (11B-hydroxylase deficiency, 17A-hydroxylase deficiency
5
Q

Couple tips on measuring blood pressure

A

Stress, pain, anxiety will raise it. Proper position (support, feet on floor). Pt not talking. White coat effect is a weird problem. BPTru = popular automated machine.

6
Q

HTN diagnosis algorithm table.

A

Add table.

7
Q

General mechanisms that can cause HTN

A

Excess hormones such as renin/angiotensin II; excess calcium entry into vascular smooth muscle; increased sympathetic outflow; increased vascular volume; increased vasoconstrictor substances / decreased vasodilator substances; abnormal response to normal constrictor / dilator signals; endothelial dysfunction or just as a manifestation of atherosclerosis

8
Q

Myths around BP (these are the correct statement)

A

Salt will only increase BP if you are destined to have HTN. Chronic stress doesn’t increase it. Coffee and smoking do not, only for 30min, then go down.

9
Q

Hyperaldosteronism and hypertension

A

.5% of all HTN, most common of endocrine. Causes: 90% Aldosterone-producing adenoma in adrenal (not often seen on CT); Bilateral Adrenal Hyperplasia; Unilateral Adrenal Hyperplasia - may be prior to bilateral adrenal hyperplasia; Glucocorticoid-remediable aldosteronism (chimera of 11βha synthetase gene) - produces aldosterone outside the zona glomerulosa

10
Q

Know the criteria to diagnose hyperaldosteronism

A

Low serum K+ (may be as high as 3.8). Next, renin - suppressed or very low; REMEMBER: renovascular hypertension can cause secondary hyperaldosteronism, sometimes sleep apnea can mimic. Next - increased aldosterone - 24 hr urine aldosterone (while on >120mmol Na diet); >49 can be abnormal; or serum measurement >440 pmol/l. Serum aldosterone: active renin >140 is abnormal

11
Q

What to do to differentiate adrenal tumor/hyperplasia (bilateral or unilateral)

A

Measure from both sides using vein through femoral artery to see if one side is higher than the other. Difficult to perform. Or use NP-59 - binds to choloesterol R in adrenal cortex.

12
Q

Cushing’s syndrome and hypertension

A

Usually obvious. They have cushing’s, and they have high blood pressure.

13
Q

Pheochromocytoma and hypertension

A

Tumor of sympathetic ganglia. 10% familial, extradrenal, bilateral and malignant. Diagnose with high metanephrines (metabolites of catecholamines)

14
Q

List the classic symptoms or “triad” suggestive of pheochromoctyoma

A

Top 3 are Headache, sweating, palpitations; also, pallor, anxiety, nausea, weight loss, tremor.

15
Q

Determine the best screening test for pheochromocytoma

A

Take a good history (get the big 3), Paroxysmal and/or severe sustained HTN despite usual therapy; HTN and symptoms suggestive of catecholamine excess (two or more of headaches, palpitations, sweating, etc); HTN triggered by ß-blockers, monoamine oxidase inhibitors, micturition, or changes in abdominal pressure; Incidentally discovered adrenal mass; Multiple endocrine neoplasia (MEN) 2A or 2B, von Recklinghausen’s neurofibromatosis (elephant man), or vHL disease.

16
Q

List conditions that mimic pheochromocytoma

A

hyperventilation, hyperadrenergic hypertension, anxiety, panic attacks, lead poisoning, migraine, dopamine surges, angina

17
Q

Tx of pheochromocytoma

A

surgical. a-blocker, some ß blocker before surgery to avoid arrhythmia.

18
Q

Syndromes of Apparent Mineralocorticoid Excess and hypertension

A

Rare, suppressed renin and aldosterone. Substances act like aldosterone. Old licorice can do that, or Liddle’s syndrome (abnormal renal Na channel)

19
Q

Hyperthyroidism and hypertension

A

sensitize body to adrenaline,

20
Q

Hypothyroidism and hypertension

A

TRH has hypertensive effect