Thread by @NadiaJamilMD

The first afternoon session at #AACECVMET is "Endocrine Hypertension and Cardiovascular Effects" by Richard Auchus, MD, PhD, FACE (@EndocrinologyM), moderated by L. Maria Belalcazar, MD, FACE (@utmbhealth)! #EndoTwitter #WeAreAACE

@EndocrinologyM @utmbhealth Pheochromocytoma Cardiovascular & Metabolic complications include commonly tachycardia & HTN, but also MI, ventricular rupture, catecholamine cardiomyopathy, hemorrhagic stroke, aortic dissection, and hyperglycemia+fatty liver+ weight loss together! #AACECVMET #Endotwitter

@EndocrinologyM @utmbhealth Primary Aldosteronism is excess renin-independent aldosterone & the most common cause of secondary HTN! There are low rates of screening & diagnosis (<1% ever screened). It has higher end-organ damage than primary HTN. It is curable or treatable with targeted therapy. #AACECVMET

@EndocrinologyM @utmbhealth 14-fold increase in rate of atrial fibrillation in patients with primary aldosteronism, worsened by hypokalemia! #AACECVMET

@EndocrinologyM @utmbhealth Note: Screening for primary aldosteronism is more about whether renin is suppressed than about whether aldosterone is high! Most meds increase PRA & Aldo (except BB decrease PRA) so if PRA is suppressed, the screen is valid. Can always rescreen after off meds! #AACECVMET #AACE

@EndocrinologyM @utmbhealth Dr. Auchus's advice for screening for primary aldosteronism: #AACECVMET #EndoTwitter @TheAACE

@EndocrinologyM @utmbhealth @TheAACE "Conn-Shing" Syndrome: large adrenal adenomas sometimes produce both aldosterone and cortisol! Arlt et al (JCI Insight 2017) noted elevated cortisol metabolites in APA that resolved with surgery. #AACECVMET #AACE

@EndocrinologyM @utmbhealth @TheAACE Pearls to using MRAs: Start low and go slowly (labs in 1-2 weeks, titrate up in 4-6 weeks; goal: normal BP &K); switch to epleronone if side effects; amiloride is an alternative though not ideal. Finerenone if DM+CKD. #AACECVMET #AACE