1、First Medical Center,health with us,1,An unusual cause of Hypertension Adrenal Glands Disorders,Case Presentation by: Dr. Babu Shersad MD, MACP American Board Certified Internal Medicine & Nephrology Venue : Dubai Sheraton Creek Date: 12/12/06 Credit Hours : 180 minutes (3hrs.) Approved by: Departme
2、nt of Health Dubai,First Medical Center,First Medical Center,health with us,2,Anatomy of the talk,Case study Hypertension and what is secondary Hypertension? Causes and Evaluation- ABCDE molecule Hyper aldosteronism Differential diagnosis Rule of 9 Points to remember,First Medical Center,health with
3、 us,3,Hypertension:,Pre Hypertension: blood pressure 120/80 mmHg to 139/89 mmHg not a disease categoryHypertension: blood pressure of 140/90 mmHg or abovethree readings 6 hours apart,First Medical Center,health with us,4,A quick review on Hypertension,First Medical Center,health with us,5,Secondary
4、hypertension,“Hypertension secondary to underlying, identifiable & often reversible cause”Why did I choose to talk on this topic? 15 25 % of hypertensive cases constitute secondary HTClient report: 42 year old teacher with HT X 15 years. Referred for quadriparesis possibile plasma pheresis Admission
5、 work up:Serum potassium 1.80 mmol /l Serum bicarbonate 28 mmol / l,First Medical Center,health with us,6,Diagnosis of Secondary Hypertension : “ABCDE” molecule,A - Accuracy, Apnea and Aldosteronism B - Bruits & bad kidneys (Renal parenchymal disease) C - Catecholamine, Co arctations & Cushings synd
6、rome D - Drugs & Diet E - Erythropoietin & Endocrine disorders,First Medical Center,health with us,7,Conditions leading to secondary hypertension,Renal artery stenosis Chronic renal disease Hyper aldosteronism Stress Sleep apnea Hyper or hypothyroidism Pheochromocytoma Pre eclampsia Aortic co-arctat
7、ions,First Medical Center,health with us,8,First Medical Center,health with us,9,First Medical Center,health with us,10,Adrenal Gland Disorder : Hyper aldosteronism,“over production of aldosterone independent of renin-angiotensin regulator system”,“Increased urinary excretion of potassium signals hy
8、per-aldosteronism which should be suspected in all hypertensive patients with unprovoked hypokalemia”,“fluid retention and increased blood pressure, weakness, and, rarely, periods of paralysis”,It leads to ,Remember,First Medical Center,health with us,11,First Medical Center,health with us,12,Signs
9、& Symptoms:,Weakness Tingling and muscle spasm Periods of temporary paralysis Thirsty Fontal headache polyuria & polydypsia Abdominal distension Ileus from hypokalemia Findings related to complications of HTN Chvosteks or Trousseaus sign “ Aldosterone escape” - due to spontaneous natruesis and diure
10、sis that occurs in these patients (no signs of edema),First Medical Center,health with us,13,Some times the clinical presentation of Hyper aldosteronism is not distinctive,the common clinical scenarios are: Patients with spontaneous or unprovoked hypokalemia, especially if the patient is also hypert
11、ensive Patients who develop severe and/or persistent hypokalemia in the setting of low-to-moderate doses of potassium-wasting diuretics Patients with refractory HTN,First Medical Center,health with us,14,Types and causes:,First Medical Center,health with us,15,Diagnostic findings:,CT scan finding,Fi
12、rst Medical Center,health with us,16,Eclampsia Carcino Adrenal Surgery Bartter SyndromeC-11 hydroxylase deficiency & C-17 hydroxylase deficiency Encephalopathy, Hypertensive Pre eclampsia (Toxemia of Pregnancy),Differential diagnosis,First Medical Center,health with us,17,But what a physician should
13、 always rule out are:,First Medical Center,health with us,18,Color doppler findings,for,Renal Artery Stenosis,First Medical Center,health with us,19,Points to remember,First Medical Center,health with us,20,These are a must (Rule of 9) ECG Urine analysis Blood glucose (9 to 12 hr fasting) Hematocrit
14、 Serum potassium Serum creatinine Serum calcium Lipid profile (LDL & HDL with triglycerides) (9 to 12 hr fasting) Albumin creatinine ratio,First Medical Center,health with us,21,First Medical Center,health with us,22,Appropriate BP measurement With verification in the contra-lateral arm Examination
15、of optic fundi BMI Auscultation of carotid, abdominal and femoral bruits Examination of heart, lungs and kidneys Seek abnormal aortic pulse Examination of edema and abnormal pulses in the lower extreme ties Neurological examination,Proper physical evaluation is a must :,First Medical Center,health w
16、ith us,23,All references from: Joint National Committees 7th Report, Mayo Clinic & American Heart Association,This is where the world is heading to “Did you hear about the baby born in the high tech delivery room?” “It was cordless!”,“No matter how hi-tech we go but a proper detection and evaluation is a must for an exact clinical diagnosis”,It is high time for us physicians to find every possible way to treat a patient for his/her root sickness. Like I say, “things happen for a reason, believe.” Thank you,
