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Flashcards in Hyperaldosteronism- Carroll Deck (10):
1

 

When is renin released?

 

What does renin do?

 

What acts as negative feedback for renin?

 

Renin is released when there is a decrease in blood pressure (IE hemorrhage, dehydration, sodium deplation)

 

Renin converts angiotensinogen into angiotensin I

 

Angiotensin II negatively feedbacks to renin

2

 

What two roles does angiotensin II have?

 

What activates angiotensin II?

 

 

 

 

 

  1. Vasoconstricts vascular smooth muscle
  2. Stimulates the adrenal gland to release aldosterone

 

Angiotensin Converting Enzyme (ACE)

3

 

What does aldosterone do?

 

Where does it act?

 

Aldosterone upregulates apical sodium channels and basolateral Na/K pumps to conserve sodium and excrete hydrogen and potassium

 

Collecting duct of the nephron

4

 

What are four classes of drugs that affect the RAAS pathway?

 

Give a drug for each class

 

  1. Direct Renin inhibitors
    • Aliskiren 
  2. ACE inhibitors
    • Lisinopril, Captopril, Enalapril
  3. Angiotensin Receptor Blockers
    • Losartan
  4. Mineralocorticoid Receptor Antagonist
    • Spironolactone 

5

 

What is the etiology behind primary hyperaldosteronism?

 

What symptoms/clinical signs are seen?

 

The adrenal gland overproduces aldosterone, due to some sort of overgrowth (cancer, hyperplasia, etc)

 

  • Hypertension younger than 30
  • Hypertension greater than 160/100
  • Hypertension with hypokalemia 
  • Resistant hypertension

6

 

What are the initial tests for primary hyperaldosteronism?

 

What are the confirmatory tests?

 

Initial Tests

  • Plasma Aldosterone Concentration >15ng/dL
  • Plasma Renin Activity <1.0 ng/mL/h
  • PAC:PRA  >20

 

Confirmatory Tests

  • Imaging of Adrenal glands
  • Bilateral renal vein sampling

7

 

What can cause primary hyperaldosteronism?

 

What can cause secondary hyperaldosteronism?

 

Primary hyperaldosteronism

  • adrenocortical adenoma
  • zona glomerulosa bilateral hyperplasia 

 

Secondary hyperaldosteronism

  • Renal Ischemia
  • Chronic Diuretic/Laxative Use
  • Hypoproteinemia
  • Renal failure
  • Heart failure

8

 

What should be done if a unilateral mass is found on the adrenals of a patient with hyperaldosteronism?

 

What should be done if both adrenals are found to be overproducing aldosteronism?

 

 

Adrenalectomy

 

Medical management (IE spironolactone, eplerenone)

9

 

What are two genetic disorders that might produce similar symptoms as primary hyperaldosteronism?

 

What causes the pathology?

 

11-Beta hydroxysteroid dehydrogenase type 2

  • Lack of 11B-HSD2 causes a build-up of cortisol
  • Cortisol can activate the mineralocorticoid receptor

 

Liddle's Syndrome 

  • mutations in the ENaC channel cause it to be constitutively active
  • potassium waste  

10

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