Thread by @amyaimei

Which is your favorite hypertension syndrome #eponym?

So a short #VisualMnemonic quiz thread on some of the #HTNsyndromes I can never remember🤔 (list is not all inclusive)

Some are better than others.🤷‍♀️If nothing else, hope it's fun.🎉
#timetostudy #boardprep

A young man comes to you with high blood pressure since teen years.

K is high, Bicarb is low.

What is the mechanism of his HTN?
(MC = mineralocorticoid)

Gordon's Syndrome/PHA2

Joseph Gordon-Levitt eating lots of acidic foods and bananas winks at you x1, not x4.

📌young age of presentation
🌟WNK1 gain or WNK4 loss of function➡️NCC activation
📌TZD sensitive
📌only syndrome with high K and acidosis
📌low renin, low aldo

Young woman with prior history of HTN now with worsening control of HTN. Currently 30 weeks pregnant with low K.

What disease state should you consider?

🌟Geller's Syndrome

Pregnant Mrs. Sarah Michelle Gellar is an "active Mrs."

📌progesterone can stimulate mineralocorticoid receptor (MR) due to a mutation
📌worse HTN in pregnancy, OCPs, spironolactone
📌Rx Na restriction, BP meds
📌low renin, low aldo

https://twitter.com/amyaimei/status/1267826718053527556

Young man with family history of HTN and early strokes comes to you for high blood pressure management after a recent stroke.

Low K, urine positive for HIGH levels of 18-hydroxycortisol and 18-oxocortisol

What is the best therapy?

Glucocorticoid Remediable Aldosteronism/FH-1

GrAce Kelly grAbs grApes for her 18 yo chimera to prevent strokes.

📌chimeric CYP11B1/B2 ➡️ACTH regulated aldo ➡️excess 11-deoxycortisol ➡️🔑"18-"steroids
📌low K with TZD
🌟Rx glucocorticoids or MR antagonist
📌low renin, high Aldo

A woman with high blood pressure presents with history of kidney stones.

Labs show
low K, alkalosis
low renin, low aldo
high urine cortisol to cortisone

What is the most likely diagnosis?
(MC = mineralocorticoid)

🌟Apparent MC Excess (AME)

"Apparently" my lizard lost 11 lbs just by eating licorice.

📌11B-HSD2 defect excess cortisol MR activation high urine metabolites
📌associated with black licorice (glycyrrhizinic acid) and itraconazole
📌Rx MR antagonist
📌low renin, low aldo