Renovascular disease

Secondary hypertension

Adrenal gland

Adrenal cortex

- zona glomerulosa – mineralocorticoid – aldosterone

- zona fasciculate – glucocorticoid – cortisol

- zona reticularis – sex hormones – androgens, extrogens

Adrenal medulla – cateholamines – adrenaline, noradrenaline

Cushing's syndrome (also called hypercortisolism or hyperadrenocorticism) is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes, including primary pituitary adenoma (known as Cushing's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer – will be and hyperpigmentation), and iatrogenic (steroid use).

1) Central obesity - fat accumulation on face, neck, trunk, but limbs are normal – displastic obesity

2) Buffalo hump – fat accumulated at lower part of neck

3) Plethoric appearance – thinning of the skin

4) Moon face – found

5) Cutaneous striae – purple atrophic line – over abdomen, buttocks and thighs

6) Hirsutism – increase of hearness, beard, moustashin women – increase adrenal androgen secretion

7) Oligomenorrhaea

8) Muscular weakness – hypokalaemia, convulsions (cramps)

9) Osteoporosis – back pain

10) Hypertension (due to cortisol's enhancement of epinephrine's vasoconstrictive effect)

11) Polyuria, nicturia, polydipsia – decrease of blood potassium

12) Insulin resistance

Laboratory investigation

1) In the blood increase in Na, Cl, Ca, glucose, decrease K, P

2) Increase AHTH adrenocorticotropic hormone, cortisol, 17OCS in urine (cortisol metabolite)

3) Ro of the scull

Hyperaldosteronism – Conn’s syndrome

Overproduction of aldosterone

Primary – adenoma

Secondary – result from stimulation of aldosterone secretion by angiotensin 2 following activation of the renine-angiotensine system.

Excess aldosterone produce sodium and water retention, potassium loss and metabolic alkalosis (due to increased secretion of H+ ions by the kidney).

Clinic features

1) Muscles weakness from hypocaliemia, tetany due to metabolic alkalosis.

2) Polyuria, polydipsia, nicturia

3) Resistant hypertension

4) Depression

5) Plasma and/or urinary aldosterone levels are elevated

6) Plasma renine activity is suppressed

Phaenchromocytoma

Is a tumor of a chromatin tissue with secretes catecholarmines (adrenaline and noradrenalin).

90% of the tumors arise from the adrenal medulla but it can also occur anywhere on the sympathetic chain.

Clinic features

1) Paroxysmal hypertension (like as crisis) associated with episodes of pallor or flushing (прилив) palpitation, sweating, skin like as goose, tremor.

2) Headache

3) Visual disturbance

4) This attacks last from several minutes to 1 hour

5) At height of attacks – hyperglycemia with glucosuria, leucocytosis, arise in t

6) Fast decreasing blood pressure (because of catecholamine broken down fast), so after pallor skin – red with profuse sweating

Laboratory investigation

1) Plasma noradrenaline and adrenaline level are rise

2) 24-hour urine vanillylmandelic acid (catecholarmines metabolite)

3) CT, ultrasonic

Renovascular disease

Renal vascular stenosis, aterosclerosis, fibromuscular displasia

1) stable high blood pressure

2) <20 or >50 years

3) Resistant hypertension to therapy

4) Murmur over renal arteries

5) Sudden dysfunctions of renal function

Дата добавления: 2015-10-29