Endocrine Hypertension

2. Topic
Endocrine Hypertension
Presenting to:Sir. Bakht Tarin Khan
Presenting by;Abdul Qahar

4. 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

5. 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.

6. 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.”

7. Blood Pressure Classification

9. 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.

10. 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

11. Hypertension affects approximately 1 billion
individual worldwide.
85 % of hypertension is essential or idiopathic.
15 % have identifiable causes of secondary HTN.

12. 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.
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13. 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

14. 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

15. Causes of Secondary HTN
Renin-Angiotensin System
Cushing’s Syndrome
Primary Aldosteronism
Pheochromocytoma
Renal Vascular Hypertension
Other

16. 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)

17. 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%

18. 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

19. CUSHING’S SYNDROME
• Results from
hypersecretion of
glucocorticoids
• Lipid reserves are
mobilized
• Adipose tissue
accumulates in
cheeks & base of
neck

20. 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

21. Renin-Angiotensin System
Renin (juxtaglomerular apparatus)
Angiotensinogen------> Angiotensin I
Angiotensin Converting Enzyme (pulmonary bed)
Angiotensin I ---------> Angiotensin II
Angiotensin II binds to specific receptors

22. #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

23. 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

24. 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

25. 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

26. 26

27. 27

28. 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

29. Drug treatment
Diuretics
 ß -Blockers
 Calcium channel blockers
 ACE inhibitors
 Angiotensin II receptor blockers
 α-Adrenergic blockers


30. 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?
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34. THANKS FOR YOUR
ATTENTION !!!