HYPERTENSİON
Hypertension is characterizied by elevation in blood
pressure. There are 2 types of hypertesion. One with no diagnostic reason
called essential hypertesion.Of all hypertesion cases 80-95% is called essential hypertension.The
other type is called as secondary hypertesion.This type has a causative effect.Before
aged 30 or after aged 55 with the new onset of hypertesion we should look for a
secondary cause another say secondary hypertesion.
SECONDARY HYPERTESİON
RENAL ARTERY STENOSİS
Renal artery stenosis can be caused by either atherosclerosis
or fibromuscular dysplasia.Athero sclerosis is mostly seen in older men, on the
other hand fibromuscular dysplasia is mostly seen in young women.Renin angiotensin
aldosteron system activation cause the hypertesion.
RENAL PARENCHYMAL DİSEASE
There will be an abormality in urine anlayses.This cause
some certain blood incredients increase such as creatinin.
COARCTATİON OF AORTA
Coarctation is usually seen in aorta at the level of left subclavian artery. This causes delayed and diminished pulse in femoral artery. Doppler echocardiography shows the region of coarctation.
PHEOCHROMACYTOMA
Pheochromacytoma is a tumor that causes the realese of
catecholamine.It is usually seen in adrenal medulla or extraadrenal paraganglion
tissue.The symptoms of pheochromacytoma are palpitation headache and diaphoresis.
Other symptoms are glucose
intolerance, wight lost and orthostatic hypotension.Pheochromacytome may also
seen on bladder wall. We may see elevated plasma metaphanephrine level or
urinary catecholamine in 24 hours urine sample.İf we see that than we order CT or
MRI to localize the tumor.
HYPERALDOSTERONİSM
Hyperaldosteronism is caused by tumors that are aldosterone
secreting adenoma or bilateral adrenal hyperplasia.Hypokalemia(low blood potassium
level) is seen on disease progression.Refractory hypertension is present in
hyperaldosteronism.
OTHER CAUSES
-Obstructive sleep apnea syndrome(OSAS)
-Oral contraceptives
-Thyroid disease
-Cushing’s syndrome
-Hypercalcemia
-Acromegaly
APROACH TO THE PATİENT
However most patients show no symptoms, in severe cases
headache, dizziness and blured vision may seen.
We should have a detailed patients history fort the diagnosis
of secondary hypertasion.
Like other diseases we should make a ohysical examination
for certain patterns.Measureing blood pressure in both arms and both legs(aortic
coarcitation). Cushingoid appearance,
thyromegaly, abdominal bruits(renal artery stenosis), and delayed femoral pulse(aorta
coarctation) are the signs of secondary hypertesion.
Labaratory:Serume creatinine, BUN, urinalysis, serum K+
measures, CXR, ECG, CBC, glucose, lipid levels, calcium, uric acid, TSH.
Specific workup:Cushingoid syndrome; dexamethasone
suppression test, renal artery stenosis; captopiril radionuclide scan,
renal duplex USG, magnetic resonance angiography, pheochromacytoma; 24 h
urine collection for cathecolamines, metanephrines and vanillymandelic acid(VMA),
primary hyperaldosteronism; deppresed plasma renin activity and
hypersecretion of aldosterone, renalparenchymal
disease.
Best wishes...
Dr. Rıdvan