Skip to content Primary Hypertension Secondary hypertension Primary Aldosterone Cushing Syndrome Presentation: -HTN, buffalo hump, moon fancies, hirsutism, easy brusing Path:
Glucocorticoids (cortisol) excess from adrenal gland due to overproduction of ACTH by pituitary adenoma -> unchecked activation of mineralocorticoid receptor Diagnosis:
absence of cortisol suppression following dexamethasone administration Treatment:
Pheochromocytoma Hyperthyroidism Elevated TH stimulates sympathetic nervous system and HTN Renovascular Hypertension Features :Most common cause of secondary hypertension, 10-15% of refractory hypertension Unilateral or Bilateral Episodic malignant hypertension Flash pulmonary edema Significant rise in creatinine when started on RAAS blocking in bilateral Causes: 1. Fibromuscular dysplasiaNon-atherosclerotic A string of beads on Radiographic of renal artery -congested/twisty renal artery Commonly seen in young females 2. AtherosclerosisMost common cause of renovascular hypertension Generally patients greater than 50 with known atherosclerosis Typically occurs in the optimum or proximal portion of renal artery -closer to the aorta Unilateral vs. Bilateral: Unilateral: -constant elevation of renin/angiotensin/aldosterone out runs the normal kidney compensation -normal kidney keeps volume low -secondary aldosterone -treat with hormone blockers Bilateral: -high BP maintained by retention of salt and water -treat with diuretics -can have significant rise in creatinine with RAAS blocker Diagnosis: Blood test: elevated renin and aldosterone Imaging: ultrasound, CT, MRI Percutaneous catheter placement to measure Intravascular pressure Treatment: RAAS, CCB, Diuretics Fibromuscular: balloon dilation Atherosclerotic: only use balloon dilation with stents in extreme cases Renal Parenchymal Hypertension Presentation: Renal Failure Hypertension Elevated Na, increase in RAAS activity, overactivity of a sympathetic nervous system Treatment: -low Na diet -diuretics -RAAS blockers (ACE-I, Angio REceptor blockers) -Beta-Blockers -Dialysis Sleep Apnea HTN occurs due to activation of the sympathetic nervous system and RAAS Suspect if snore, or ease, thick neck, or daytime sleepiness Treat:CPAP: continuous positive airway pressure Coarctation of the aorta Congenital narrowing of the aorta, on the downturn Hypertension in upper limbs, with reduced BP in lower limbs Delayer femoral pulses Kids diagnosed with imaging, surgical treatment Scroll Up error: Content is protected !!
