Adrenal causes of hypertension: Pheochromocytoma and primary aldosteronism

摘要: The clinical presentations of the patient with pheochromocytoma—a rare endocrine neoplasm—include adrenal incidentaloma, hypertensive paroxysms, sustained apparent polygenic hypertension, hypertension in pregnancy, and crisis induced by anesthesia. Although when undiagnosed a pheochromocytoma can be lethal, it usually cured surgery. Biochemical documentation measurements fractionated metanephrines catecholamines should precede imaging studies. Abdomen pelvis computed is first test. Careful preoperative pharmacologic preparation important for successful surgical outcome. Adrenal pheochromocytomas removed laparoscopically, whereas, catecholamine-secreting paragangliomas typically require an open approach. All degree relatives patients have biochemical testing. In addition, molecular genetic testing germline mutations considered most all paraganglioma. Primary aldosteronism relatively common form secondary hypertension—affecting 5 to 10% hypertension. A plasma aldosterone concentration (PAC) renin activity (PRA) ratio obtained hypokalemia, resistant incidentaloma onset at young age (e.g., < 20 years age), severe ≥160 mm Hg systolic or ≥100 diastolic), whenever clinician considering other forms PAC/PRA case finding test positive result confirmed suppression either oral intravenous sodium loading. treatment goals primary are prevent morbidity mortality associated cardiovascular damage. Both subtype preference dictate