Primary Hypertension due to Endocrine adrenal Hypertension Adrenogenital syndrome Oral Contraceptives

Endocrine Hypertension adrenal Hypertension

  • primary hyperaldosteronism there is sodium retention ion with loss of potassium. So there is
  • natremia and hypokalemia with hypertension.
  • diagnosis is by serum K+ level estimation.
  • hyperaldosteronism may be due to a tumor
  • Iateral adrenal hyperplasia. The tumor may be removed and the hypertension curable.
  • diseasese patients of hypertension are not given so­ , then there is no hypertension. Because of so­- retention and volume expansion plasma renin is decreased.

Cushing’s S ndrorne :

  • In Cushing syndrome there —-eased amount of glucorticosteroids which causes retention. There is also increased production eralocorticoids in Cushing’s syndrome. There increased production of renin substrate. All ause hypertension.

Adrenogenital syndrome 4

Primary Hypertension due to Endocrine adrenal Hypertension

Adrenogenital syndrome:

  • In adrenogenital syn­drome there is C – 11 or C-17 hydroxylase deficiency and increased production of deoxycorticosterone re­sulting in increased sodium retention with hyperten­sion and decreased PRA (Plasma Renin Activity).

Pheochromocytoma :

  • There is increased secretion of epinephrine and nor-epinephrine by a tumor, (usu­ally in adrenal medulla). This results in peripheral vasoconstriction and cardiac stimulation.
  • Diagnosis is by detection of urinary epinephrine and norepinephrine and their metabolites.

Acromegaly :

  • In acromegaly there is hypertension, coronary atherosclerosis and LVH (left ventricular hypertrophy)

Hypercalcemia :

    • High calcium blood level is associated with increased incidence of hypertension.
    • Calcium entry blockers are effective antihypertensive agents.
  •  In’ hyperparathyroidism there is nephrolithiasis, nephrocalcinosis as a result of which there is renal parenchymal damage and hyperten­sion. Increased calcium levels have direct vasocon­strictor effect also. High intake of calcium is associ­ated with decreased incidence of hypertension.

Oral Contraceptives

  • Estrogen containing oral contraceptives causes hy­pertension.
  • In OC with low dose estro en, activation of renin an­giotensin aldosterone mechanfsm is responsible for nypertension.
  • Due to angiotensin II there is potent vasoconstrictor effect.
  • Due to aldosterone, blood volume increases leading to hypertension.
  • Estrogen stimulates hepatic synthesis of renin sub­strat~-angioten§inog~n so there is increased produc­~ of angiotensin II and secondary aldosteronism.
  • Some women develop hypertension with use of oral contraceptive if they are more than 35 yrs age, obese, there is high estrogen content of oral contraceptive, mild renal disease, increased vascular sensitivity to estrogen or angiotensin II, family history of hyper­tension.