Primary and Secondary Hypertension Flashcards Preview

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Flashcards in Primary and Secondary Hypertension Deck (14):
1

How many cases of HTN are primary? Secondary?

- primary: 85 - 90%
- secondary: 10 - 15%

2

What are the two leading causes of Secondary HTN?

- renal disease and primary aldosteronism

3

Primary Aldosteronism is also known as:

- Conn's syndrome

4

How can we tell the difference between Secondary HTN due to Renal Disease vs. due to Primary Aldosteronism?

- in renal disease, there will be high aldosterone AND high renin (the renin will cause the aldosterone)
- in primary aldosteronism, there will only be high aldosterone

5

Other than Renal Disease and Primary Aldosteronism, what are three other causes of Secondary HTN?

- phaeochromocytoma, Cushing's disease, congenital adrenal hyperplasia

6

Phaeochromocytoma

- tumor(s) in the adrenal gland, resulting in an increase in adrenaline or noradrenaline
- can lead to paroxysmal/episodic bursts of secondary HTN

7

Cushing's Disease

- gluco-corticoid excess usually due to an issue with the hypothalamic-pituitary-adrenal axis
- the excess cortisol can lead to secondary HTN

8

Pathophysiology of Cushing's Disease in the context of a broken hypothalamic-pituitary-adrenal axis.

- hypothalamus secretes CRH, causing the pituitary gland to secrete ACTH, which triggers the adrenal cortex to release cortisol (excess cortisol --> high BP)

9

What can cause Cushing's Disease?

- prolonged use of corticosteroids (iatrogenic), ACTH hypersecretion from a pituitary adenoma, ectopic ACTH secretion, cortisol hypersecretion from adrenal issue

10

Congenital Adrenal Hyperplasia

- 95% of cases are due to a 21-hydroxylase deficiency (secondary HTN does NOT occur in these patients)
- 5% are due to an 11-hydroxylase deficiency (secondary HT DOES occur here)

11

In Primary Aldosterone, what type of cells would you see on histology of the malignant adrenal gland?

- tons of glomerulosa type cells (these cells are responsible for aldosterone secretion)

12

ACTH

- adrenocorticotropic hormone
- secreted by the pituitary gland in response to the hypothalamus' CRH
- acts on the adrenal cortex to stimulate release of cortisol

13

CRH

- corticotropin releasing hormone
- secreted by the hypothalamus in response to stress and low blood glucose
- acts on the pituitary gland to stimulate the release of ACTH

14

Cortisol

- secreted by the zona fasiculata in the adrenal cortex
- increases blood glucose via gluconeogenesis, suppresses immune system, and increases metabolism of fat, protein, and carbohydrates