Endocrine hypertension By Abdul Qahar


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Endocrine Hypertension

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Endocrine hypertension By Abdul Qahar

  1. 1. Topic Endocrine Hypertension Presenting to:Sir. Bakht Tarin Khan Presenting by;Abdul Qahar
  2. 2. Overview of the Endocrine System • System of ductless glands that secrete hormones – Hormones are “messenger molecules” – Circulate in the blood – Act on distant target cells – Target cells respond to the hormones for which they have receptors – The effects are dependent on the programmed response of the target cells – Hormones are just molecular triggers 4
  3. 3. What the High Blood Pressure and Prehypertension are? Blood pressure is the force of blood against the walls of arteries. Blood pressure rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure. The medical term for high blood pressure is hypertension.
  4. 4. Hypertension (HTN) “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defines hypertension as a blood pressure exceeding 139/89 mm Hg for adults ages 18 years or older on the mean of 2 or more properly seated BP readings on each of 2 or more office visits.”
  5. 5. Blood Pressure Classification
  6. 6. Hypertension Hypertension is the most common public health problem in developed countries Called Silent Killer No cure is available, but prevention and management decrease the incidence of hypertension and disease.
  7. 7. Prevalence Prevalence on hypertension by age Age 18~29 30~39 40~49 50~59 60~69 70~79 80 + % Hypertension 4 11 21 44 54 64 65
  8. 8. Hypertension affects approximately 1 billion individual worldwide. 85 % of hypertension is essential or idiopathic. 15 % have identifiable causes of secondary HTN.
  9. 9. Types of Hypertension  In ~80–95% of hypertensive patients are diagnosed as having "essential" hypertension (also referred to as primary or idiopathic hypertension).  In the remaining 5–20% of hypertensive patients, a specific underlying disorder causing the elevation of blood pressure can be identified.  In individuals with "secondary" hypertension, a specific mechanism for the blood pressure elevation is often more apparent. Renal disease is the most common cause of secondary hypertension. 12
  10. 10. Hypertension : Symptoms Most of the patients do not complain of any symptoms Symptomatic patients may have one or more of the following symptoms - Headache - Confusion - Severe shortness of breath - Visual disturbances - Nausea and vomiting
  11. 11. Causes of Hypertension 1- Primary hypertension (90 – 95%) - Essential hypertension 2- Secondary hypertension (5 – 10%) - Renal diseases - Endocrine disease - Steroid excess - Growth hormone excess - Vascular causes - Drugs
  12. 12. Causes of Secondary HTN Renin-Angiotensin System Cushing’s Syndrome Primary Aldosteronism Pheochromocytoma Renal Vascular Hypertension Other
  13. 13. Pheochromocytoma Secrete catecholamines which can produce severe HTN Cause: 10% arise outside the adrenal 10% of those in adrenal are bilateral 10% are malignant(to harm other) 10% arise in children 10% occur in association with other endocrine neoplasm (tumour)
  14. 14. Aldosterone and Hypertension • Primary aldosteronism as described by Conn in 1955 had been thought to be an uncommon cause of hypertension with prevalence of < 1% among hypertensive patients • Gordon et al in early 1990s screened 52 hypertensive pts and found that 12% of the individuals were positive for primary aldosteronism • In a follow up study by Gordon evaluation of 199 pts referred to a hypertension clinic found a prevalence of primary aldosteronism to be at least 8.5%
  15. 15. Aldosterone and Hypertension • Since the early studies by Gordon multiple investigators have confirmed a prevalence of primary aldosteronism of 5-15% in general selective hypertensive population. Two studies in particular: • Schwartz and Turner evaluated 118 pts with hypertension and withdrew antihypertensive treatment. Diagnosis of primary aldosteronism was made with 4 day salt load and lack of suppresion of aldosterone secreation • Primary aldosteronism was diagnosed in 13% of individuals
  16. 16. CUSHING’S SYNDROME • Results from hypersecretion of glucocorticoids • Lipid reserves are mobilized • Adipose tissue accumulates in cheeks & base of neck
  17. 17. Hyperaldosteronism  Excessive aldosterone causes HTN low blood Ca2+ low blood renin  Primary usually from cortical adenoma or hyperplasia  Secondary usually caused by impaired renal blood flow due to renal artery stenosis from atherosclerosis  involves renin-angiotensin
  18. 18. Renin-Angiotensin System Renin (juxtaglomerular apparatus) Angiotensinogen------> Angiotensin I Angiotensin Converting Enzyme (pulmonary bed) Angiotensin I ---------> Angiotensin II Angiotensin II binds to specific receptors
  19. 19. #1. Angiotensin II binds to its receptors and causes: A. B. C. D. E. Inhibition of aldosterone secretion Peripheral vasoconstriction Inhibits central sympathetic activity Stimulates ACTH stimulation Inhibits vasopressin release
  20. 20. Renin-Angiotensin System Angiotensin II functions to maintain normal extracellular volume and blood pressure 1. 2. 3. 4. 5. constricts vascular smooth muscle release of Epinephrine and Norepinephrine increases central sympathetic outflow release of vasopressin increases aldosterone secretion
  21. 21. Renin-Angiotensin System Low renal perfusion sensed by JG apparatus Low Na load to distal tubule sensed by macula densa Upright posture increase CNS stimulation All enhance renin secretion-->increased angiotensin II and aldosterone levels
  22. 22. Renin-Angiotensin System Feedback at multiple levels renin release can be inhibited by high salt diet and high blood pressure Aldosterone secretion sensitive to both potassium and sodium levels
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  25. 25. Hypertension - Management  Life style modification:  Regular physical exercise  Stop smoking  Stop alcohol  Dietary controls : weight control  Restrict salt intake 4-6 gm/day  Restrict saturated fats
  26. 26. Drug treatment Diuretics  ß -Blockers  Calcium channel blockers  ACE inhibitors  Angiotensin II receptor blockers  α-Adrenergic blockers 
  27. 27. The correct Approach to Hypertension • Are all patients screened for hypertension? Step1 • Are all hypertensives correctly identified? • Are the correct drug combinations prescribed? Step 2 • What is the compliance for medicines? • Is the goal B.P. achieved and maintained? Step 3 • Are there any complications/ side effects? 30