endookriiin

8/18/2019 endookriiin

1/95

PEMICU 4 B

BLOK ENDOKRIN

Jessica

405100080


2/95

Perumusan masalah

1!"#a #en$e%a% &ia men'a&i sema(in )emu(* +!"#a #en$e%a% ,er'a&i #enin)(a,an BB $an) &iser,ai

(e#ala #usin)- ,e(anan &arah ,in))i &alam . %ulan* /!"#a #en$e%a% hai& ,i&a( ,era,ur*

4!ura,an arna #u,ih &en)an &asar (emerahan #a&a#eru,-#aha- len)an menun'u((an mani2es,asi (linis &ari#en$a(i, a#a*

5!a!"#a a&a hu%un)an (3nsumsi 3%a, &arah ,in))i&en)an (eluhan #asien*

%! Men)a# ,elah minum 3%a, &arah ,in))i-,ensi ,e,a#,in))i*

C!"#a(ah #a&a (elainan (elen'ar a&renal-&arah ,in))i-&i%eri 3%a, ,e,a# ,in))i*


3/95

.! a!Men)a#a #emeri(saan ,e(anan &arah &ila(u(an #a&a(e&ua len)an *

%! "#a ar,in$a 'i(a hasil &i&a#a,(an #a&a (e&ua len)an%er%e&a* c!Bera#a %a,asn3rmal #er%e&aan ,e(anan &arah (anan &an (iri*

! a!Men)a#a #emeri(saan na&i &ila(u(an #a&a len)an&an (a(i*

%!"#a ar,in$a 'i(a hasil #a&a (e&ua len)an &an (a(i

%er%e&a*c! Bera#a %a,as n3rmal #er%e&aan #a&a len)an

&an (a(i* 8!"#a in,er#re,asi hasil #emeri(saan RR &an suhu* !Bera#a IM6 n$a &an a#a s,a,us )i7i n$a*

10!Bera#a %a,as n3rmal D &an in,re#e,asin$a* 11 a!"#a #en$e%a% (alium ,urun * %!"#a hu%un)an (a&ar (alium ren&ah &en)an

(eluhan*


4/95

"N"6OMI Kelen'ar a&renal a&alah se#asan) 3r)an

$an) ,erle,a( &e(a, (u,u% a,as )in'al-,er%enam &alam 'arin)an lema(!

Kelen'ar ini a&a + %uah- %erarna(e(unin)an ser,a %era&a &i luar 9e(s,ra:#eri,3neal!

se%elah (anan %er%en,u( #$rami& &anmem%en,u( ,3#i 9mele(a,: #a&a (u,u%a,as )in'al (anan!

e&an)(an $an) se%elah (iri %er%en,u(se#er,i %ulan sa%i,- menem#el #a&a%a)ian ,en)ah )in'al mulai &ari (u,u%a,as sam#ai &aerah hilus )in'al (iri

Kelen'ar a&renal #a&a manusia#an'an)n$a 4;. cm- le%ar 1;+ cm- &an

,e%al 4;. mm- %era, le%ih (uran) 8 )! ar,eri a&alah arteri suprarenalis

superior - %erasal &ari ar,eri 2reni(ain2eri3r< arteri suprarenalis media-%erasal &ari a3r,a < &an arterisuprarenalis inferior - %erasal &ari ar,eri

renalis


5/95


6/95


7/95

=as(ularisasi "&renal

=as(ularisasi

>arteri suprarenalissuperior - %erasal &ariar,eri 2reni(a in2eri3r<

>arteri suprarenalismedia- %erasal &aria3r,a

>arteri suprarenalisinferior - %erasal &ariar,eri renalis!


8/95


9/95


10/95

Zona Glomerulosa

l3merul3sa A#alin) luar! >6e#a, &i%aah sim#ai

>el #3lihe&ral(ecil%er(el3m#3(mem%en,u( %ula,an !in,i )ela#- si,3#lasma%as32ili(!

>Pen)hasilmineral3(3r,i(3i&9al&3s,er3n $an) ,er(ua,:


11/95

Zona Fasikulata

@3na 2asi(ula,a > Le%ih ,e%al > ,er&iri a,as sel #3lihe&ral

%esar &en)an

si,3#lasman$a %as32ili(! > eln$a ,ersusun %er&ere,lurus se,e%al + sel-&en)an sinus3i& en3sa%er,in)(a# $an) 'alann$a%er'a'ar &an &ian,ara&ere,an i,u!

> el;sel men)an&un)%an$a( ,e,es li#i&-23s23li#i& - asam lema( -lema( &an (3les,er3l!

> el ini 'u)a %an$a(men)an&un) i,amin C&an mense(resi(an(3r,i(3s,er3i&!


12/95

Zona Retikularis

@3na re,i(ularis > La#isan ini ,er&iri a,as

&ere,an sel %ula,

%erca%an) > ca%an)%er(esinam%un)an!

>el;seln$a #en)hasilh3rm3n (elamin9#r3)es,er3n -

es,r3)en an&r3)en:! >el ini 'u)a

men)an&un) i,aminC!


13/95

Hormones of Adrenal Cortex

C3r,ic3s,er3i&s

> "l&3s,er3ne 9)l3merul3sa:

Mineral3c3r,ic3i&

>C3r,is3l 92ascicula,a:

luc3c3r,ic3i&

>e? h3rm3nes 9re,icularis:

"&renal an&r3)ens


14/95


15/95


16/95


17/95


18/95

Mechanism: Norepinephrine

Release and Recycling

Figure 11-9: Norepinephrine release at a varicosity of a sympathetic neuron


19/95

Daily secretion rates and plasma concentrations of

adrenal steroids

4% unbound

40% unbound

Cortisol equal affinity for the aldosterone receptor


20/95

Glukokortikoid kortisol! E2e( me,a%3li(

> lu(3ne3)enesis

> Li#3lisis

> Pemecahan #r3,ein

mem%ua, (a&ar )lu(3sa menin)(a,- a)ar &a#a, &i)una(an3leh 3,a( (arena 3,a( han$a &a#a, mema(ai )lu(3saF! Un,u(me,a%3lisme 3r)an lainn$a ener)i &a#a, &ihasil(an &ari#en)3lahan asam lema(- asam amin3- &ari #r3ses &i a,as

E2e( #ermisi2 un,u( a(,i2i,as h3rm3n lain

"&a#,asi s,ress

E2e( an,i in2lamasi &an imun3su#resi2 > 6i&a( %3leh ,erus menerus

Kelainan Penyakit Penyebab Gejala


21/95

Kelainan Penyakit Penyebab Gejala

Kelebihanaldosteron

Hiperaldosteron primer(sind. onn!

Hiperaldosteron se"under

#umor $onaglomerulosayang

berprodu"siberlebihan%ening"atanberlebihan

sist. &enin-angiotensin

Hipernatremia'hipo"alemia'

hipertensi

Kelebihan"ortisol

indromcushing

Kelebihan&H dan

atau )#H

Kelebihanglu"osa'

protein' dandistribusilema"abnormal

Kelebihan indrom #ida" +as"ulinisasi


22/95


23/95

Cushin) s$n&r3meCushin) s$n&r3me

$n&r3m Cushin) a&alah sua,u (ea&aan$an) &ise%a%(an 3leh e2e( me,a%3li()a%un)an &ari #enin))ian (a&arglukokortikoid &alam &arah $an) mene,a#

$an) men$e%a%(an #eru%ahan #a&a(ea&aanA >Me,a%3lisme #r3,ein &an (ar%3hi&ra, >Dis,ri%usi 'arin)an a&i#3sa >Ele(,r3li, >is,em (e(e%alan >e(resi lam%un) >Gun)si 3,a( >Eri,r3#3esis >Mene(an #era&an)an


24/95


25/95

Klasi2i(asiKlasi2i(asi


26/95


27/95

Bu22al3 hum# an& m33n 2ace


28/95

"&ance Cushin)Hs


29/95


30/95


31/95


32/95

Mem"edakan penye"a" cushing syndrome

in&r3m cushin) hi#32isisA

> "C6 menin)(a,- ,i&a( &a#a, &i,e(an &en)an

#em%erian &e(s,ame,as3n &3sis ren&ah

> 6i&a( a&a #enurunan e(s(resi 1;hi&r3(si;(3r,i(3s,er3i& &alam urin

"&en3ma (3r,i(3,r3#

> Beres#3ns ,erha&a# in'e(si &e(,ame,as3n&3sis ,in))i! Menurun(an se(resi "C6

#enurunan e(s(resi s,er3i& urineF


33/95

Mem"edakan penye"a" cushing syndrome

e(resi "C6 e(,3#i(

> "C6 menin)(a,

> 6i&a( %eres#3n ,h& &e(s,ame,as3n &3sis

,in))i &an ren&ah

6um3r a&renal

> "C6 san)a, ren&ah

> Pem%erian &e(s,ame,as3n &3sis ,in))i a,au

ren&ah ,i&a( mem#en)aruhi #r3&u(si (3r,is3l


34/95

#enatalaksanaan

"&ren3,3mi Me,ira#3n

>Me(anisme (er'a A men)aham%a, 11;;hi&r3(silase

> In&i(asi A un,u( men)u'i (emam#uan hi#32isishi#er(3r,is3lisme

>e&iaan A 3ral +50 m) >E A hi#er,ensi

"min3)lu,e,imi& >Me(anisme (er'a A men)ham%a, (3nersi

(3les,r3l men'a&i #re)nen3l3n > In&i(asi A sin&r3m cushin) %ila &i(3m%inasi(an

&en)an me,ira#3n


35/95

$%M#&'$A(' Os,e3#3r3sis

i#er,ensi

Ki&ne$ s,3nes Dia%e,es


36/95


37/95

in&r3m C3nn

E,i3l3)i #rimer > 91: unila,eral al&3s,er3ne;#r3&ucin) a&en3ma

9"P": 3r C3nn s$n&r3me 950;.0 32 cases: an&

> 9+: i&i3#a,hic h$#eral&3s,er3nism 9I": 3r%ila,eral a&renal h$#er#lasia 940;50 32 cases:!

E,i3l3)i e(un&er >Penurunan #er2usi )in'al

>i#33lemia ar,eri &an e&ema >Kehamilan

&enin mening"at


38/95

Manifestasi $linis

>i#er,ensi &ias,3li( rin)an hin))a se&an)-

sa(i, (e#ala- (elemahan 3,3,- #3liuria-

#3li&i#sia

>6an#a e&ema #eri2er (arena 2en3menamel3l3s(an &iri &ari re,ensi Na

> i#3(alemia- hi#erna,remia- al(al3sis

me,a%3li(

H ld t i


39/95

Hyperaldosteronism)

*iagnosis

erum K /!. mEL

Plasma renin ac,ii,$ 9PR": 1 n)ml

Plasma al&3s,er3ne Q++ n)&L Urine al&3s,er3ne Q 14 mc)+4hrs

Urine K Q 40 mE+4 hrs

Plasma al&3s,er3neAPR" ra,i3 Q 50A1


40/95

(pironolactone

C3m#e,es i,h al&3s,er3ne 23r rece#,3r

si,es in &is,al renal ,u%ules- increasin)

a,er e?cre,i3n hile re,ainin) #3,assium

an& h$&r3)en i3ns! Ma$ %l3c( e22ec,s 32al&3s,er3ne 3n ar,eri3lar sm33,h muscles

Adult 100 m) PO & ini,iall$- increase ,3

400 m)& #rn 23r c3n,r3l 32 %l33& #ressure #ediatric N3, es,a%lishe&


41/95

(pironolactone

In,erac,i3nsA > Bl3c(s ,es,3s,er3ne %i3s$n,hesis an& #eri#heral

an&r3)en ac,i3n- causin) im#3,ence- &ecrease& li%i&3-an& )$nec3mas,ia

> ma$ cause mens,rual irre)ulari,ies in 3men< hi)h&3ses increase hal2;li2e 32 &i)3?in 9a&'us, &i)3?in &3se:

> a3i& c3nc3mi,an, ,hera#$ i,h salic$la,es %ecause,he$ &ecrease e22ec,ieness

> c3nc3mi,an, ,hera#$ i,h "CE inhi%i,3rs 3rin&3me,hacin has %een ass3cia,e& i,h seereh$#er(alemia


42/95

(pironolactone

KIA D3cumen,e& h$#ersensi,ii,$< anuria< renal2ailure< h$#er(alemia

#regnancy D ; Ge,al ris( sh3n in humans<

use 3nl$ i2 %ene2i,s 3u,ei)h ris( ,3 2e,us #recautions N3, rec3mmen&e& &urin)

#re)nanc$ %ecause ma$ cr3ss #lacen,a< inmale 2e,us- ma$ cause #seu&3herma#hr3&ism<

n3, rec3mmen&e& in nursin) m3,hers %ecause32 e?cre,i3n in %reas, mil(< cau,i3n in renal an&he#a,ic im#airmen,


43/95


44/95

IPEREKREI

"LDO6ERON

IPEREKREI


45/95

IPEREKREI

"LDO6ERON Dise%a%(an 3A

e(resi %erle%ihan ,um3r 73na )l3merul3sa a&renal $) ,er&iri &arisel+ #en)hasil al&3s,er3n (indrom Conn +hiperaldosteronismeprimer,!

Pe %erle%ihan a(,ii,as sis,em R"" 3!( (elainan $) men$e%a%(an#eS(r3ni( aliran &arah (e )in'al- misA #en$em#i,an ar,eri renalis 3!(a,er3s(ler3sis hiperaldosteronisme sekunder !Pen$e%a% lainA 3!(&ehi&rasi 9misal- #er&arahan:- (e)a)alan 'an,un)-&an sir3sis ha,i! Ber%e&a &en)an $an) #rimer- #a&ahi#eral&3s,er3nisme se(un&er ,i&a( ,er'a&i HNa esca#eH sehin))aa(an &i,emui )e'ala e&ema!

Di,an&ai &en)an (a&ar renin #lasma &an &i,emu(an #a&a (ea&aan

$an) %er(ai,an &en)anA S #er2usi )in'al i#33lemia ar,eri &an e&ema Kehamilan

G (, Ri i(


46/95

Ga(,3r Risi(3

i#eral&3s,er3nisme Tani,a

"na(;ana( a,au &easa mu&a


47/95


48/95

Mani2es,asi Klinis i#eral&3s,er3nisme

i#er,ensi

i#3(alemia

Ka&ar renin serum ren&ah

i#er,ensi


49/95

Dia)n3sis

i#eral&3s,er3nisme C6 scan

"&renal ein sam#lin)

Urinar$ 18;h$&r3?$c3r,is3l > elea,e& in a&en3ma!

#lasma h$&r3?$c3r,ic3s,er3ne 93erni)h, recum%en,:; Q 100

in a&en3ma

erum K /!. mEL

Plasma renin ac,ii,$ 9PR": 1 n)ml

Plasma al&3s,er3ne Q++ n)&L

Urine al&3s,er3ne Q 14 mc)+4hrs

Urine K Q 40 mE+4 hrs

Plasma al&3s,er3neAPR" ra,i3 Q 50A1

6 , L (


50/95

6a,a La(sana

i#eral&3s,er3nisme Bila,eral h$#er#lasia;me&ical-

s#ir3n3lac,3ne- amil3ri&e!

Unila,eral a&en3ma; a&renalec,3m$!


51/95

in&r3m "&ren3)eni,al

Kele%ihan s,er3i& an&r3)eni( 9testosteron &anse'enisn$a: meru#a(an sua,u (ea&aan $an)men$e%a%(an virilisasi - &imana ,er'a&i #er(em%an)anciri (e'an,anan $an) %erle%ihan- %ai( #a&a #ria mau#unani,a!

erin) ,er'a&i (ele%ihan an&r3)en $an) %ersi2a, rin)an-,e,a#i han$a men$e%a%(an menin)(a,n$a #er,um%uhanram%u, 9hirsutisme:!=irilisasi $an) se'a,i 'aran) ,er'a&i- han$a se(i,ar 1;+

(asus #a&a se,ia# 100!000 ani,a!


52/95

E6IOLOI

E,i3l3)in$a $ai,u ne3#lasma a,au

hi#er#lasia a&renal (3n)eni,al

i#er#lasia a&renal (3n)eni,al

mencermin(an se(el3m#3( #en$a(i,

resesi2 au,3s3mal- masin);masin)

&i,an&ai &en)an &e2e( here&i,er #a&a

sua,u en7im $an) ,erli%a, &alam%i3sin,esis (3r,is3l


53/95

Mani2es,asi Klinis

e'ala &ari irilisasi a&alahA #er,um%uhan ram%u, &i a'ah &an ,u%uh (e%3,a(an

'eraa, suara men'a&i le%ih %era, 3,3, mem%esar!

Pa&a ani,a- rahim men)(isu,- klitoris mem%esar- #a$u&ara men)ecil &an si(lus

mens,ruasi %erhen,i!Pria &an ani,a %isa men)alami #enin)(a,an)airah se(sual!


54/95


55/95

PEN"6"L"K"N""N

"&en3ma #en)hasil an&r3)en &an (an(er

a&renal %iasan$a &ia,asi &en)an men)an)(a,

(elen'ar a&renal!

Pa&a hi#er#lasia a&renal &i%eri(an se'umlah(ecil (3r,i(3s,er3i& 9misaln$a &e(same,as3n: -

$an) %iasan$a a(an men)uran)i

#em%en,u(an s,er3i& an&r3)eni(! 6e,a#i 'i(a

&3sis $an) &i%eri(an ,erlalu ,in))i- 3%a, ini 'u)a %isa men$e%a%(an sindroma Cushing !


56/95

Insu2isiensi "&renal


57/95

De2inisi

Bila salah sa,u (elen'ar a&renal ,&( %er2un)si &ian)(a,

(elen'ar sa,un$a a(an men)am%il alih 2un)sin$a &en)an

cara hi#er#lasia hi#er,r32i!

Den)an &emi(ian- un,u( ,er'a&in$a insu2isiensi

a&ren3(3r,e(s- (e&ua 3r)an harus ,er(ena 9Q 80 harusrusa(:!


58/95

E,i3l3)i

"(u, > in&r3m Ta,erh3use;Gri&erichsen

> Pen)hen,ian men&a&a( ,era#i (3r,i(3s,er3i& 'an)(a #an'an)

> ,res #a&a #asien $an) su&ah men)i&a# insu2isiensi a&renal(r3nis

Kr3nis > Pen$e%a% u,ama

"&renalisis au,3imun

6u%er(ul3sis

in&r3m imun3&e2isiensi &i&a#a, Pen$a(i, me,as,a,i(

> Pen$e%a% min3r "mil3i&3sis sis,emi(

In2e(si 'amur

em3(r3ma,3sis

ar(3i&3sis


59/95

Acute Adrenal 'nsufficiency

De2inisiAe(resi $an) ina&e(a, &aria&ren3(3r,i(3s,er3i&- &a#a, ,er'a&i se%a)ai hasil&ari se(resi "C6 $an) ,i&a( cu(u# a,au (arena(erusa(an &ari (elen'ar a&renal &a#a, se%a)ian

a,au seluruhn$a! Klasi2i(asiA > Chr3nic #rimar$ a&renal insu22icienc$ 9"&&is3n

&isease: > Chr3nic sec3n&ar$ a&renal insu22icienc$ > "cu,e a&renal insu22icienc$ 9"&renal Crisis:

Ch i # i Ad l ' ffi i


60/95

Chronic #rimary Adrenal 'nsufficiency

+Addison *isease,

6er'a&i (erusa(an (elen'ar a&renal secaralam%a,

6er'a&i &e2isiensi (3r,is3l- al&3s,er3ne- &ana&renal an&r3)en &an (ele%ihan &ari "C6&an CR $an) %erhu%un)an &en)anhilan)n$a feedback negatif


61/95

E,i3l3)i

"u,3imun 9 0 ; 0 (asus: In2e(si

> 6BC > is,3#lasm3sis

> I= > $#hilis

Ke)anasan > me,as,ase &ari #aru;#aru

> carcin3ma c3l3n > melan3ma > l$m#h3ma


62/95

6an&a &an e'ala

Ke(uran)an K3r,is3l Lemah %a&an Ce#a, lelah "n3re(sia

Mual Mun,ah Diare i#3)li(emi

i#er,ensi 3r,3s,a,i(rin)an i#3na,remi E3sin3#hilia

Ke(uran)an "l&3s,er3n i#er,ensi 3r,3s,a,i( i#er(alemia i#3na,remia

Ke(uran)an "n&r3)en Kehilan)an %ulu &i a?illa

&an #u%is

Kele%ihan "C6 i#er#i)men,asi (uli, &an

#ermu(aan mu(3sa


63/95

Dia)n3sis

Peri(sa (a&ar (3r,is3l %aseline #a&a #a)i

hari &an "C6- lalu &ila(u(an c3s$n,r3#in

9"C6: s,imula,i3n ,es,! Ka&ar (3r,is3l

%iasan$a ren&ah &an (a&ar "C6 ,in))i &ane(s3)en "C6 ,i&a( menin)(a,(an (3r,is3l

(arena (elen'ar a&renal ,i&a( %er2un)si!

Pemeri(saan le%ih lan'u, ,er)an,un) &ari(emun)(inan #en$e%a% #en$a(i, $ai,u

au,3imun- in2e(si &an (e)anasan


64/95


65/95

A t Ad l ' ffi i +$ i i


66/95

Acute Adrenal 'nsufficiency +$risis

Addison,

ua,u (ea&aan )aa, &arura, $an)

%erhu%un)an &en)an menurunn$a a,au

(e(uran)an h3rm3n $an) rela,i2 &an,er'a&in$a (3la#s sis,em (ar&i3as(uler

&an %iasan$a )e'ala )e'alan$a n3n

s#esi2i(- se#er,i mun,ah &an n$eria%&3men


67/95


68/95


69/95

i)n s$m#,3m

$3( $an) suli, &i'elas(an e,i3l3)in$a %iasan$a ,i&a(a&a #en)aruh &en)an #em%erian resusi,asi cairan a,auas3#res3r!

i#3,ermia a,au hi#er,ermia $an) %erhu%un)an &en)an(e(uran)an (3r,is3l $ai,u ce#a, lelah- lemah %a&an-an3re(sia- mual mual &an mun,ah - &iare- hi#3)li(emi-hi#3,ensi- hi#3na,remi-

Van) %erhu%un)an &en)an (e(uran)an h3rm3nal&3s,er3n $ai,u hi#er(alemia &an hi#3,ensi %era, $an)mene,a#

Lain lain ,er)an,un) &ari #en$e%a%- mun)(in &i&a#a,(an#anas %a&an- n$eri a%&3men &an #in))an) $an)%erhu%un)an &en)an #er&arahan (elen'ar a&renal

NEOPL"M" MEDUL"


70/95

NEOPL"M" MEDUL"

"DREN"L Ge3(r3m3si,3ma

Neur3%las,3ma


71/95

GEOKROMOI6OM"


72/95


73/95

Phe3chr3m3c$,3ma

10 e?,raa&renal

10 %ila,eral

102amilial

10chil&ren

10 mali)nan,

10 ass3c i,h MEN 9mul,i#le en&3crinene3#lasia:

10 #resen, i,h a s,r3(e


74/95

E6IOLOI

in&r3ma en&3(rin mul,i#el

Pen$a(i, 3n i##el;Lin&au

Pen$a(i, 3n Rec(lin)hausen9neur32i%r3ma,3sis- #er,um%uhan,um3r %er&a)in) #a&a sara2:!


75/95

EJ"L"

i#er,ensi 6a(i(ar&i Ber(erin)a,

%erle%ihan Pusin) 'i(a %er&iri 6a(i#neu Mu(a (emerahan

Kuli, &in)in &anlem%a%

a(i, (e#ala he%a, N$eri &a&a &an #eru, Mual

Mun,ah an))uan#en)liha,an

Jari ,an)an(esemu,an

K3ns,i#asi


76/95

DI"NO"

Pemeri(saan urine un,u( men)e,ahui (a&ar (a,e(3lamin C6 can- &a#a, mel3(alisir 0;5 ,um3r $an)

&iame,ern$a le%ih &ari 1 cm MRI

Nuclear Ima)in) Pe, cannin)


77/95

PEN"6"L"K"N""N

#en)an)(a,an 2e3(r3m3si,3ma

Biasan$a 2en3(si%en7amin &an #r3#an3l3l&i%eri(an %ersamaan

me,ir3sin un,u( men)en&ali(an ,e(anan &arah

(em3,era#i %eru#a si(l323s2ami&- in(ris,in &an&a(ar%a7in %ila %elum me,as,asis


78/95

Neur3%las,3ma

6um3r s3li& e(s,rs(ranium $an) ,erserin)

#a&a ana(; ana(! Palin) serin) ,er'a&i

#a&a 5 ,ahun #er,ama (ehi&u#an &an

mun)(in muncul se'a( %a$i!


79/95

Da#a, ,im%ul &imana sa'a #a&a sis,em

sara2 sim#a,is &an (a&an) &i &alam3,a(- ,e,a# umumn$a &i a%&3men!

e%a)ian %esar (asus ,im%ul &i me&ula

a&renal a,au )an)li3n sim#a,isre,r3#eri,3neum!

e%a)ian %esar %ersi2a, s#3ra&i(-

mes(i#un a&a 'u)a $an) 2amilial!


80/95

$#er,ensi3n

Persis,en, elea,i3n 32 ar,erial %l33& #ressure 9BP:

Na,i3nal ui&eline

> ,h Re#3r, 32 ,he J3in, Na,i3nal C3mmi,,ee 3n ,he

De,ec,i3n- Ealua,i3n- an& 6rea,men, 32 i)h Bl33&

Pressure 9JNC:

W+ milli3n "mericans 9/1: hae BP Q 1400 mm)

M3s, #a,ien,s as$m#,3ma,ic

Car&i3ascular m3r%i&i,$ m3r,ali,$ ris( &irec,l$

c3rrela,e& i,h BP< an,ih$#er,ensie &ru) ,hera#$

re&uces car&i3ascular m3r,ali,$ ris(

80hobanian )3' a"ris 45' lac" H&' et al. eventh report of the 6oint National ommittee on %revention' ,etection'7valuation' and #reatment of High lood %ressure. Hypertension 8;18?8.

6 O D


81/95

6ar)e,;Or)an Dama)e

BrainA s,r3(e- ,ransien, ischemic a,,ac(-&emen,ia

E$esA re,in3#a,h$

ear,A le2, en,ricular h$#er,r3#h$- an)ina

Ki&ne$A chr3nic (i&ne$ &isease

Peri#heral =ascula,ureA #eri#heral ar,erial&isease

81


82/95

8+

E,i l


83/95

E,i3l3)$

Essen,ial h$#er,ensi3nA

> Q 0 32 cases

> here&i,ar$ c3m#3nen,

ec3n&ar$ h$#er,ensi3nA > 10 32 cases

> c3mm3n causesA chr3nic (i&ne$ &isease-

ren3ascular &isease > 3,her causesA R? &ru)s- s,ree, &ru)s- na,ural

#r3&uc,s- 233&- in&us,rial chemicals

8/

C 2 +X , i


84/95

Causes 32 +X $#er,ensi3n

Diseaseschr3nic (i&ne$ &isease

Cushin)Hs s$n&r3me

c3arc,a,i3n 32 ,he a3r,a

3%s,ruc,ie slee# a#nea

#ara,h$r3i& &isease

#he3chr3m3c$,3ma

#rimar$ al&3s,er3nismren3ascular &isease

,h$r3i& &isease

84

M h i 2 P ,h i


85/95

Mechanisms 32 Pa,h3)enesis

Increase& car&iac 3u,#u, 9CO:A

> increase& #rel3a&A

increase& 2lui& 3lume

e?cess s3&ium in,a(e renal s3&ium re,en,i3n

> en3us c3ns,ric,i3nA

e?cess R"" s,imula,i3n

s$m#a,he,ic ner3us s$s,em 3erac,ii,$

85

M h i 2 P ,h i


86/95

Mechanisms 32 Pa,h3)enesis

Increase& #eri#heral resis,ance 9PR:A > 2unc,i3nal ascular c3ns,ric,i3nA



)ene,ic al,era,i3ns 32 cell mem%ranes en&3,helial;&erie& 2ac,3rs

> s,ruc,ural ascular h$#er,r3#h$A



)ene,ic al,era,i3ns 32 cell mem%ranes

en&3,helial;&erie& 2ac,3rs

h$#erinsulinemia &ue ,3 3%esi,$- me,a%3lic s$n&r3me

8.

"&ul, Classi2ica,i3n


87/95

"&ul, Classi2ica,i3n

Classification(ystolic .lood

#ressure +mmHg,*iastolic .lood

#ressure +mmHg,

N3rmal Less ,han 1+0 an& Less ,han 80

Preh$#er,ensi3n 1+0;1/ 3r 80;8

,a)e 1 h$#er,ensi3n 140;15 3r 0;

,a)e + h$#er,ensi3n Q 1.0 3r Q 100

8hobanian )3' a"ris 45' lac" H&' et al. eventh report of the 6oint National ommittee on %revention',etection' 7valuation' and #reatment of High lood %ressure. Hypertension 8;18?8.


88/95

88

)7: angiotensin-converting en$yme; )&: angiotensin receptor bloc"er; : calcium channel

bloc"er;,%: diastolic blood pressure; %: systolic blood pressure


89/95

8@9

Li2es,$le M3&i2ica,i3ns


90/95

Li2es,$le M3&i2ica,i3ns

Modification RecommendationApproximate (ystolic .lood#ressure Reduction

+mm Hg,

a

Tei)h, l3ss Main,ain n3rmal %3&$ ei)h, 9%3&$ massin&e? 18!5>+4! ()m+:

5>+0 #er 10;() ei)h, l3ss

D";,$#e&ie,ar$ #a,,erns

C3nsume a &ie, rich in 2rui,s- e)e,a%les-an& l3;2a, &air$ #r3&uc,s i,h a re&uce&c3n,en, 32 sa,ura,e& an& ,3,al 2a,

8>14

Re&uce& sal,in,a(e

Re&uce &ail$ &ie,ar$ s3&ium in,a(e asmuch as #3ssi%le- i&eall$ ,3 .5 mm3l&a$91!5 )&a$ s3&ium- 3r /!8 )&a$ s3&iumchl3ri&e:

+>8

Ph$sical ac,ii,$ Re)ular aer3%ic #h$sical ac,ii,$ 9a, leas,/0 min&a$- m3s, &a$s 32 ,he ee(:

4>

M3&era,i3n 32alc3h3lin,a(e

Limi, c3nsum#,i3n ,3 + &rin(s&a$ in menan& 1 &rin(&a$ in 3men an& li)h,er;ei)h, #ers3ns

+>4

0

,)H' ,ietary )pproaches to top Hypertension.a 7Aects of implementing these modications are time and dose dependent and could begreater for some patients.

,i%iro 6#' #albert &5' Bee 4' +at$"e 4&' Cells 4' %osey 5+: %harmacotherapy:) %athophysiologic )pproach' Dth7dition: http:EE.accesspharmacy.comE


91/95

"CE Inhi%i,3rs

+n& line ,3 &iure,ics 23r m3s, #a,ien,sBl3c( an)i3,ensin I ,3 an)i3,ensin II c3nersi3n "CE 9"n)i3,ensin C3ner,in) En7$me: &is,ri%u,e& in

man$ ,issues#rimaril$ en&3,helial cells%l33& esselsA ma'3r si,e 23r an)i3,ensin II #r3&uc,i3n

Bl3c( %ra&$(inin &e)ra&a,i3n< s,imula,e s$n,hesis 323,her as3&ila,in) su%s,ances such as #r3s,a)lan&in

E+ #r3s,ac$clinPreen, 3r re)ress le2, en,ricular h$#er,r3#h$ %$

re&ucin) an)i3,ensin II m$3car&ial s,imula,i3n

1


92/95

+98

M3ni,3rin) "n,ih$#er,ensies


93/95

M3ni,3rin) "n,ih$#er,ensies

Class #arameters

Diure,ics %l33& #ressureBUNserum crea,inineserum elec,r3l$,es 9KY- M)+Y- NaY:uric aci& 923r ,hia7i&es:

;Bl3c(ers %l33& #ressurehear, ra,e

"l&3s,er3ne an,a)3nis,s "CE inhi%i,3rs "n)i3,ensin II rece#,3r%l3c(ers Direc, Renininhi%i,3rs

%l33& #ressureBUNserum crea,inineserum #3,assium

Calcium channel %l3c(ers %l33& #ressurehear, ra,e

/,i%iro 6#' #albert &5' Bee 4' +at$"e 4&' Cells 4' %osey 5+: %harmacotherapy:) %athophysiologic )pproach' Dth7dition: http:EE.accesspharmacy.comE

(esim#ulan


94/95

(esim#ulan

6elah &i#ela'ariA

KasusA

saran


95/95

saran

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