Endocrine hypertension
1.Mineralocorticiods excess -Conns Syndrome2.Phaeochromocytoma
3.Cushing syndrome
4.Hyperparathyrodism
5.Acromegaly
6.Thyroid dysfunction
Mineralocorticoids excess
HypokalemiaPoor 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
Managment__Mineralocorticoid receptor antagonist (Spironolactone)
-- Surgical removal of adrenal adenoma
PhaeochromocytomaRare 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.Constipation5.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 MRI4. Scan or selective venous sampling
Management
SurgeryBefore surgery alpha blocker –Phenoxybenzamine for 6 weeks
During surgery nitroprusside with shortacting alpha blocker phentolamine
Postoperative hypotension may occur and require IV fluid