• Acromegaly
• Also raises glucose
• NSAIDs
• Pheochromocytoma (cf MEN IIa)
  
• => HTN, flushing, sweating
• May cause hypercalcaemia (but may be due to concurrent hyperparathyroidism in MEN IIa)
  
• Risk of death! Must exclude

• Autosomal dominant disorder characterized by early, and frequently severe, hypertension
• Looks like hyperadosteronism
  
• Low plasma renin activity
• Metabolic alkalosis due to hypokalemia
• But normal to low levels of aldosterone
• Involves abnormal kidney function
• Caused by dysregulation of an epithelial sodium channel (ENaC)
• Treatment
  
• Low sodium diet
  
• Potassium-sparing diuretic that directly blocks the sodium channel
• Amiloride or triamterene
• Spironolactone is not effective because it acts by regulating aldosterone and Liddle syndrome does not respond to this regulation
  

• Varapamil
• Diltiazem
• Amlodipine
• Nifedipine
• Felodipine
• Nicardipine
• Lercanidipine

Side effects

• CCBs
• Ankle swelling
• Gingival hyperplasia
  
• Diuretics
• Gout
• Impotence
• ACEi
• Impotence
• Cough
• Renal impairment if renal artery stenosis

Contraindications

• CCBs
• Heart failure
• ACEi
• Pregnancy
• Renal artery stenosis
• Diuretics
• CKD
• Beta blockers
• Asthma
• Alpha blockers
• Almost none - Very safe!
  

• Carcinoid
• => Tachycardia but NOT HTN
• Test 5-HIAA
• Bilateral adrenal hyperplasia is more common than adrenal adenoma as a cause of hyperaldosteronism
• Beading of renal arteries
  
• Sign of fibromuscular dysplasia
• Can cause HTN
• Lifestyle measures are at least as good as one drug
• Aged, black => CCB
• Then A+C
• Then A+C+D
• Aliskiren = Direct renin inhibitor
• Losartan is now off-patant
• => First choice, as there's no cough
• However half-life is only 2 hours (but can still take OD)
• ACEi/ARB help protect kidneys in HTN if there's concurrent diabetes or nephropathy