Flashcards in Endocrine hypertension and hypoglycemia Deck (41):
1
What is the most common symptom of hypertension
Asymptomatic...by the time headache and pulmonary edema come around you are usually already in trouble
2
Hypokalemia
Cramps, EKG changes, etc...
3
What are the three major endocrine causes of hypertension
- Cushing's syndrome (excess cortisol)
- Pheocromocytoma (excess catecholamines)
- Hyperaldosteronism
4
What is the first thing you'll notice in a pt with Cushing's syndrome
Obesity (moon face, edema, etc..) KNOW!!!
5
What will a pt with pheocromocytoma often present with
headaches, pounding heart rate, excessive sweating, etc.. KNOW!!!
6
How might you test to make sure that something is disobeying physiological regulation in regards to aldosterone release
Infuse saline and see if Aldosterone levels are still high. Remember, the RAAS (renin-angiotensin-aldosterone system) has one main function, that is to retain sodium. If you give Saline (containing sodium) and the aldosterone doesn't drop, you've got a problem.
7
Why would you measure aldosterone and renin levels simultaneously?
Renin drives aldosterone secretion. If renin is high, the increased aldosterone levels are explained (this is called secondary hyperaldosteronism). If Renin is low, you know it is a primary aldosterone problem.
8
What are the four leading causes of Endocrine hypertension
Aldosterone-producing Adenoma
Bilateral Adrenal Hyperplasia
Glucocorticoid suppresible aldosteronism
Adrenal Carcinoma
9
Pheochromocytoma
catecholamine producing tumor of chromaffin cells that typically produces hypertension
10
What is the rule of tens in pheochromocytoma
10% are malignant and 10% are extra-adrenal
11
Pheochromocytoma can be familial
-auto dominant
- Multiple endocrine neoplasia
- hyperparathyroidism and medullary thyroid carcinoma
12
Hypoglycemia is frequent in who?
Diabetics
13
What numbers = HTN
systolic over 140, diastolic over 90
14
Low Renin HTN pts respond better to what types of medications
Diuretics and Calcium channel blockers
15
High Renin pts respond better to?
ACEi
16
What is the major source of Epinephrine in the plasma?
Adrenal Medulla....this makes E a hormone in the traditional sense
17
Norepinephrine is less of a hormone and more of a neurotransmitter
Most of the Norepinephrine is gone once it is released from the sympathetic axon terminals
18
MEN 2A
Pheochromocytoma, hyperparathyroidism, medullary carcinoma
19
MEN 2B
Pheo, multiple mucosal, medullary carcinoma
20
How do you remember the MENs
Both MEN 2A and 2B include pheochromocytoma and medullary carcinoma of the thyroid.
2A includes hyperpArAthyroidism (2 A's in para)
2B mucosal neuroma
21
Pheochromocytoma is a tumor of what types of cells
chromaffin
22
Clinical signs of Pheo
headache, tachycardia, sweating, episodic htn
23
Metabolic features of pheochromocytoma
Hypercatabolism and hyperglycemia (due to high level of catecholamines which, as we know, depress insulin secretion and encourage glucagon secretion and glucose production in liver).
24
Diagnosis of pheochromocytoma
Increased serum metanephrines and 24 hour urine metanephrines or catecholamines (either one will work)
25
90% of pheochromocytomas are located where
Adrenal medulla
26
99% of pheochromocytomas are where?
in the abdomen
27
In summary, pheo dx is done by:
sugestive clinical evidence, plasma/urine catecholamines, localization by CT or MRI
28
Mineralocorticoid receptors are activated by what?
Aldosterone AND cortisol (weakly)
29
Why does cortisol activate mineralocorticoid receptors only weakly?
It is converted to cortison in the kidneys by 11Beta hydroxysteroid dehydrogenase
30
Mineralocorticoid excess causes what two pathologic conditions
Hypertension- Due to high intravascular plasma volume
Hypokalemic Alkalosis
31
What things that you would expect to happen with aldosterone excess do NOT happen?
Hypernatremia and edema...hypernatremia is pretty well controlled by ADH and thirst.
32
Mechanism of Aldosterone secretion:
Renin (from JGA) ---> Ang 1 ---> converted to Ang 2 by ACE in endothelial cells---> Ang 2 stimulates aldosterone secretion which increases plasma sodium, increases ECF, which is sensed by JGA and renin production stops
33
ANG 2 is also a potent vasoconstrictor!!!! KNOW
it increases BP directly in this way
34
Primary hyperaldosteronism=
usually an adrenal adenoma. Renin will be low because negative feedback will be intact
35
Secondary hyperaldosteronism
Increased renin secretion due to volume loss or some condition where congestive heart failure
36
What is used to diagnose primary hyperaldosteronism
aldosterone: renin ratio
37
Hypertension and spontaneous hypokalemia means you should suspect
Primary hyperaldosteronism
38
Aldosterone:Renin over 30
suspect primary hyperaldosteronism
39
Aldo : Renin over 50
Definitely primary hyperaldo
40
Glucocorticoid excess =
Cushings
41