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1、AnunusualcauseofHypertension AdrenalGlandsDisordersCasePresentationby:Dr.BabuShersadMD,MACPAmericanBoardCertifiedInternalMedicine&NephrologyVenue:DubaiSheratonCreekDate:12/12/06CreditHours:180minutes(3hrs.)Approvedby:DepartmentofHealthDubaiFirstMedicalCenterFirstMedicalCenter1heal
2、thwithusAnatomyofthetalkCasestudyHypertensionandwhatissecondaryHypertension?CausesandEvaluation-ABCDEmoleculeHyperaldosteronismDifferentialdiagnosisRuleof9PointstorememberFirstMedicalCenter2healthwithusHypertension:PreHypertension:bloodpressure120/80mmHgto139/89mmHgnotadiseasecate
3、goryHypertension:bloodpressureof140/90mmHgorabovethreereadings6hoursapartFirstMedicalCenter3healthwithusAquickreviewonHypertensionFirstMedicalCenter4healthwithusSecondaryhypertension“Hypertensionsecondarytounderlying,identifiable&oftenreversiblecause”WhydidIchoosetotalkonthistopic
4、?15–25%ofhypertensivecasesconstitutesecondaryHTClientreport:42yearoldteacherwithHTX15years.ReferredforquadriparesispossibileplasmapheresisAdmissionworkup:Serumpotassium1.80mmol/lSerumbicarbonate28mmol/lFirstMedicalCenter5healthwithusDiagnosisofSecondaryHypertension:“ABCDE”molecule
5、A-Accuracy,ApneaandAldosteronismB-Bruits&badkidneys(Renalparenchymaldisease)C-Catecholamine,Coarctations&Cushing’ssyndromeD-Drugs&DietE-Erythropoietin&EndocrinedisordersFirstMedicalCenter6healthwithusConditionsleadingtosecondaryhypertensionRenalarterystenosisChronicrenaldiseaseHyp
6、eraldosteronismStressSleepapneaHyperorhypothyroidismPheochromocytomaPreeclampsiaAorticco-arctationsFirstMedicalCenter7healthwithusHyperthyroidismLability,irritability,palpitations,muscleweakness,weightloss,diarrhea,heatintolerance,menstrualirregularityTremor,finehair,onycholysis,l
7、idlag,proptosis,tachycardia,atrialfibrillation,widepulsepressure.Elevatedthyroidhormones,suppressedthyrotropin.Cushing’ssyndromeWeakness,weightgain,amenorrheaMoonfacies,acne,supraclavicularfatpad,purplestriaonabdomen/thighs,edemaIncreasedplasmacortisol,increasedurinary17-ketoandhy
8、droxysteroidsCoarctationoftheaort
