Hyperaldosteronism Flashcards Preview

Endocrine > Hyperaldosteronism > Flashcards

Flashcards in Hyperaldosteronism Deck (23):
1

Treatment protocol for pheochromocytoma

1. Alpha blockade (Phenoxybenzamine)

2. Beta blockade to treat Alpha blockade-related tachycardia

3. Hydration

4. Surgical resection adrenlalectomy

2

presenting symptoms Pheochromocytomas

HTN

headaches

Diaphoresis

palpitation

orothstaic changes

3

renin levels in primary, secondary hyperaldosteronism

primary - suppressed

secondary- increased

3

Apparent mineral corticoid excess

 

pathophys

 

presentation

impaired 110beta hydroyxsteroid dehydrogenase-2 (11-HSD2)

(deactivates cortisol to cortisone in the kindey, which lacks strong mineral corticoid activity  (returned via 11-HSD1) high relative cortisone concentration negates aldosterone regulation of mineralcorticoid receptor

presentation: HTN, hypokalemia, metaboic alkalosis

low renin activity

low aldosterone

normal cortisol

4

screening test for suspected primary hyperaldosterims

plasma aldosterone:renin activity ratio 

 

increased ratio indicates primary hyperaldosteronism (aldosterone increased, renin suppressed) (normal ratio is

4

best imaging modality to locate biochemically confirmed pheochromocytomas

CY scan of abdomen/adrenal glands

(somatostaing receptor scannning with labeled octreotide if not located)

5

Liddle syndrome pathophys

mutations in amiloride sensitive epithelial channel > enahnced sodium reabsorption, K wasting, HTN, hypokalemia

 

low renin and aldosterone levels

6

enzyme of adrenals that converts NE to Epi

 

implication of this location?

PNMT

 

adrenal locations allows Pheochromcytomas to secrete NE and Epi, while Paraganglionomas secrete NE

7

mineral corticoid antagonists

 

therapeutic action

spironolactane, eplerenone

bloack aldosterone action > reduce soidum and water retention 

9

ACE inhibitor impact on renin

increases activity and concentration

10

consider primary hyperaldosteronism for

HTN and hypokalemia

resisten HTN

adrenal incentalmoma and HTN

young HTN (

severe HTN

11

Pheocromocytoma vs Pragangliomas morphology and secretions

Pheo - tumors of chromaffin cells of adrenal medulla. Secrete  Epi and NE

 

paragangliomas - tumors of extra-adrenal ganglia of the sympathetic nervous system. Secrete predominantly NE

 

13

in primary hyperaldosteronism

 

impact on renin production

negative feedback decreases renin production (which leads to decreased angiotensin)

14

screening for pheochromocytomas

Plasma free metanephrines and urinary catecholamines

15

etiology AME

glycyrrhizic acid - licorice+tobaccos - decreased 11-HSD2

autosomal recessive

16

angiotensin II increases BP via

vasoconstriction

increased aldosterone release from adrenal cortex

16

alpha agonist

 

beta 2 agonist

Phenylephrine

 

albuterol

18

treatment, liddle syndrome

 

Amiloride, traimterene (k sparing diuretics)

 

mineralcorticoid receptor antagonists ineffective

19

treatment in cases of bilateral hyperaldosteronism

mineralcorticoid receptor antagonists

spironolactone  + eplerenone

20

determine if primary hyperaldosteronism is unilateral or bilateral adrenal source via

adrenal CT

adrenal vein sampling (high levels one side, unaffected should be lower)

21

direct renin inhibiotor, decreases activity (not concentration) 

aliskerin

22

ARBs

losartan

cadesartan

irbesartan

23

clinical presentation hyperaldosteronism

HTN

hypokalemia