Endocrine hypertension - Causes, Symptoms and Treatment .MF .
Hypertension is called the persistent increase in arterial pressure above 140/90 mm HgThe most common (90-95% of all cases) can not identify the reasons for the disease, while hypertension is called essential .In a situation where the increased pressure associated with any disease state, it is considered secondary (symptomatic) .Symptomatic hypertension is divided into four main groups: kidney, hemodynamic, endocrine and central.
In the structure of morbidity endocrine hypertension occupies 0.1-0.3%.Given the widespread hypertension, almost every doctor repeatedly meets with endocrine hypertension in their practice.Unfortunately, often it remains undiagnosed pathology and patients receive ineffective treatment for years that provokes complications of vision, kidney, heart, brain vessels.In this article, we will discuss the main points of the symptoms, diagnosis and treatment of arterial hypertension associated with disorders of the endocrine glands.
When you need a detailed survey?
Secondary hypertension is rarely diagnosed (about 5% in Russia).However, it can be assumed that in some cases the nature of the secondary pressure increase is simply not detected.Do any of the patients can be suspected of such a situation?Here are the main groups of patients requiring detailed inspection:
- those patients who have the maximum dose of antihypertensive drugs on the standard schemes do not lead to normalization of pressure-resistant;
- younger patients (under 45 years) with severe hypertension (180/100 mm Hg or higher);
- Patients with hypertension whose relatives at a young age had a stroke.
In some of these patients, primary hypertension, but this can be ascertained only after a detailed examination.The plan must enable a diagnosis and a visit to an endocrinologist.This doctor will evaluate the clinical picture and possibly prescribe hormonal tests.
What endocrine pathology leads to hypertension?
endocrine glands produce a special signal connections - hormones.These substances are actively involved in the maintenance of a constant internal environment of the body.One of the direct or indirect function of the hormone is the maintenance of adequate blood pressure.First of all we are talking about adrenal hormones - glucocorticosteroids (cortisol), mineralocorticoids (aldosterone), catecholamines (epinephrine, norepinephrine).Also, a role played by thyroid hormones and thyroid hormone pituitary growth.
cause pressurization with endocrine disease can be, firstly, sodium and water retention in the body.Secondly, hypertension hormone stimulates activation of the sympathetic nervous system.The high tone of this division of the autonomic nervous system leads to heart palpitations, increased force of contraction of the heart muscle, blood vessels narrowing diameter.Thus, pathology adrenal, thyroid gland, pituitary gland could be the basis of hypertension.Let's touch on every detail of the disease.
- severe chronic disease that often causes the pituitary tumor that produces growth hormone.This substance, among other things, affect the exchange of sodium in the body, causing an increase in its concentration in the blood.As a result, the excess liquid is delayed and the circulating blood volume increases.Such adverse changes lead to a persistent increase in blood pressure.Patients with acromegaly have a very characteristic appearance.Growth hormone promotes thickening of the skin and soft tissues, brow, thickening of the fingers, feet increase in size also increases the lips, nose, tongue.Changes in appearance occur gradually.They always need to confirm by comparing photographs of various years.If a patient with a typical clinical picture is revealed more and hypertension, the diagnosis of acromegaly is becoming more likely.
For accurate diagnosis is necessary to determine the concentration of growth hormone in the blood of fasting and after receiving 75 grams of glucose.Another important analysis - IGF-1, venous blood.For imaging of the pituitary tumor is best suited magnetic resonance or computed tomography with contrast agent administration.
Upon confirmation of the diagnosis of acromegaly often surgical treatment.Basically performed transnasal removal of the pituitary tumor.Radiotherapy is performed if the operation is impossible.Treatment only drugs (somatostatin analogues) is rarely used.This therapy plays a supporting role in the periods before and after radical surgery.
- a condition caused by the excessive concentration of thyroid hormones in the blood.The most common trigger hyperthyroidism Graves' disease, toxic adenoma, subacute thyroiditis.Thyroid hormones affect the cardiovascular system.Under the influence of their heart rate quickens sharply, increases cardiac output, narrowed lumen of blood vessels.All this leads to the development of resistant hypertension.Such hypertension will always be accompanied by nervousness, irritability, insomnia, weight loss, sweating, "heat" in the body, trembling fingers.
hormonal studies are assigned to confirm the diagnosis of hyperthyroidism: thyroid-stimulating hormone (TSH), thyroxine (T4 free), triiodothyronine (T3 free).
If the diagnosis is confirmed, the treatment begins with conservative therapy tireostatikami.Next, operation or radioisotope treatment can be carried out.
The adrenal medulla hormones normally produced by "fear and aggression" - adrenaline and noradrenaline.Under their influence quickens the heart rate, force of contraction of the heart muscle, blood vessels narrows the lumen.If the adrenal glands or rarely occurs outside of their tumor that produces these hormones uncontrollably, then it is a disease pheochromocytoma.The main feature of the presence of hypertension crises is considered at this endocrine pathology.In 70% of cases of persistent pressure increase will not.Observed only episodes of a sharp rise in blood pressure numbers.The cause of these crises is the release of catecholamines in the blood of tumor.The crisis is accompanied by a classic case of sweating, heart palpitations and feelings of fear.
To confirm the diagnosis of the patient appoint additional examination in the form of analysis and nonmetanefrina Metanephrine in urine or blood.Also spend adrenal imaging by ultrasound or computed tomography.
The only effective treatment is considered to be an operation of tumor removal.
's disease and Cushing's syndrome
Cushing's disease is a tumor in the pituitary gland, and the syndrome - adrenal.The consequence of these diseases becomes excessive secretion of glucocorticoids (cortisol).As a result of the patient not only activates the sympathetic division of the autonomic nervous system and develops hypertension.Typical are mental disorders until the acute psychosis, cataracts, obesity in the abdomen, trunk, neck, face, acne, bright blush on the cheeks, hirsutism, stretch marks on the skin of the abdomen, muscle weakness, bruising, bone fractures with minimal trauma, menstrual disorderswomen diabetes.
To clarify the diagnosis is carried out in the determination of the blood concentration of cortisol in the morning and at 21 o'clock, then can be held large and small samples with dexamethasone.For the detection of the tumor is performed magnetic resonance imaging of the pituitary and ultrasound or CT scan of the adrenal glands.
treatment is preferably carried out surgically removing the tumor in an adrenal or pituitary gland.Radiation Therapy Cushing's disease have also been developed.Conservative measures are not always effective.Therefore, drugs play a supporting role in the treatment of disease and Cushing's syndrome.
Increased secretion of aldosterone in the adrenal glands can be a cause of hypertension.The cause of hypertension in this case, it is fluid retention in the body, increasing blood volume.High blood pressure is permanent.Status virtually corrected by conventional antihypertensive drugs for the standard circuits.This disease is accompanied by muscle weakness, tendency to seizures, palpitations copious urination.
analyzed to confirm the diagnosis of potassium, sodium, renin, aldosterone in blood plasma.It is also necessary to perform imaging of the adrenal glands.
Treatment of primary aldosteronism spend spironolactone (veroshpiron).Doses sometimes reach up to 400 mg per day.If the cause of the disease has become a tumor - it requires surgery.
Endocrine arterial hypertension have a bright clinical picture.Also there is always a high pressure, and other symptoms of excess of a hormone. the diagnosis and treatment of this pathology are engaged together endocrinologist, cardiologist, surgeon.Treatment of the underlying disease leads to a full normalization of blood pressure numbers.
endocrinologist Tsvetkova IG