Endocrine hypertension

Fifth stage

Endocrine hypertension
Lec-1
د.جاسم محمد

1/1/2014

1.Mineralocorticiods excess -Conns Syndrome
2.Phaeochromocytoma
3.Cushing syndrome
4.Hyperparathyrodism
5.Acromegaly
6.Thyroid dysfunction

Mineralocorticoids excess

Hypokalemia
Poor control of blood pressure
Presentation at young age group


Aetiology:
1. Renin high+ aldosterone high(secondary hyperaldosteronism)
Inadequate renal perfusion
Renal secreting tumour
2. Renin low + aldosterone high( Primary hyperaldosteronism)
Adrenal adenoma secreting aldosterone (Conns)
Idiopathic bilateral adrenal hyperplasia
3. Renin low + aldosterone low
Ectopic ACTH secretion
Liquorice misuse Liddles syndrome

Clinical assessment

1.Asymptomatic
2.hypernateriamia features (Edema)
3.hypokalemia features(muscle weakness ,paralysis,tetany,polyuria)
4.Hypertension

Investigations

1--Serum electrolytes K ,HCO3,Na.
2--Plasma Renin activity and Aldosterone.
3--Primary hyperaldosteronism Adenoma versus bilateral adrenal hyperplasia(standing ,frusemide).
4--CT abdomen ,Adrenal vein cath,Adrenal scan


Management: -Mineralocorticoid receptor antagonist (Spironolactone)
-Surgical removal of adrenal adenoma
Phaeochromocytoma
Rare tumour of chromaffin cells
Rule of tens 10% malignant,10%familial ,10%extraadrenal

Clinical features

1.Hypertension
2.Paroxysms of pallor,palpitation ,sweating ,headache,anxiety
3.Abdominal pain ,vomiting
4.Constipation
5.Weight loss
6.Glucose intolerance
7.Complications of hypertension (stroke,Heart failure ,myocardial infarction

Investigations

1. Messurment of plasma catecholamines or their metabolites(vanillyl-mandilic acid in urine.
2. Clonidine suppression test.
3. abdominal CT or MRI
4. Scan or selective venous sampling


Management
Surgery
Before surgery alpha blocker –Phenoxybenzamine for 6 weeks
During surgery nitroprusside with shortacting alpha blocker phentolamine
Postoperative hypotension may occur and require IV fluid