espn teaching point 9 treatment approach to genetic arterial hypertension
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ESPN Teaching Point 9 Treatment approach to genetic arterial hypertension. Case report The eleven month old boy was admitted because of mild myocardial hypertrophy and persistently elevated blood pressure (140/80 mmHg, > 97 percentile) - PowerPoint PPT PresentationTRANSCRIPT
Case report
The eleven month old boy was admitted because of mild myocardial hypertrophy and persistently elevated blood pressure (140/80 mmHg, > 97 percentile)
Family history revealed several cases of essential hypertension
Next steps:
Is there a primary impact of family history on first diagnostic steps ?
Next steps:
Is there a primary impact of family history on first diagnostic steps ?
If you assume genetic hypertensionhow do you proceed ?
Basic investigations Kindey normal Funduscopy no pathology ECG hypertrophy no ECHO size and function normal Duplex-ultrasound kidney no pathology Abdominal ultrasound no vascular
abnormality Captopril scintigraphy no pathology
Endocrine workup
Sodium, potassium normal PRA, serum aldosterone normal Epinephrine, norepinephrine normal
Cortisol, ACTH normal 11-desoxycortisol normal DHEA, NPY, testosterone normal
Steroid profile in urine
Tetrahydrocortisol + 5 tetrahydrocortisol / tetrahydrocortison
Defect of 11-hydroxysteroid dehydrogenase (11 HSD)
11 HSD is the key enzyme in the process of interconversion of cortisol and cortisone
Cortisol binding to mineralocorticoid receptor stimulates the receptor
Genetic anlaysis of the 11 HSD gene was performed.
Genetic analysis Homozygous mutation in exon 2 at codon 161
(Leucine161Glycine)
Worldwide only 50 patients with AME described (infant hypertension, low birth weight, hypokaliemic alkalosis, low plasma renin and low aldosterone)
Recommended therapy: aldosterone antagonist