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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pheochromocytoma is an infrequent cause of hypertension. In spite of its rarity, pheochromocytoma has assumed notorious importance because or a wide variety of clinical features associated with this syndrome. Hypertension remains the most important clinical lead. The presence of other features, such as severe headache, perspiration, palpitations or orthostatic hypotension, makes the diagnosis of pheochromocytoma likely. The diagnosis of this condition can be made with greater certainty than that of any other form of secondary hypertension. Pharmacologic tests are no longer used for evaluation purposes. Biochemical tests are the most important aids to diagnosis, provided highly specific methods are used to determine the levels of urinary catecholamines or their metabolites. Interference by various drugs should be avoided. Most of the pheochromocytomas are found in the abdomen, predominantly in the adrenals. Successful outcome of surgery depends critically on adequate preoperative preparation of the patient with adrenergic blocking drugs and proper intraoperative care. Surgery should only be performed in an institution with experience in treating these tumors. Invasive localizing procedures could be dangerous in patients with pheochromocytoma and are best avoided. Medical therapy proves to be quite successful for those patients who are unable or unwilling to undergo surgery and for those with demonstrated malignant tumor. The postoperative course in most instances is uneventful. The physician should be aware of familial forms of pheochromocytomas and screen all the hypertensive members of the patient's family for the presence of this condition. Pheochromocytoma, with its multiple facets, presents a challenge to the clinician; however, with prompt diagnosis and proper treatment, pheochromocytoma can often be cured. The improved management of patients with this potentially lethal condition is the result of better knowledge of biochemical pharmacology, improved preoperative, surgical and postoperative care.
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PMID:Pheochromocytoma--recognition and management. 4 12

38 cases of Takayasu's arteritis were reported. The mean age of onset was 23.3 years with a female: male ratio of 1:1.7. The median delay between first symptom and time of diagnosis was 12.2 years. Headache was the most common symptom of neurologic manifestations (55%). Major neurologic events occurred in 52.7% patients in this group, including TIA, cerebral infarction, hypertensive encephalopathy, lacunar infarct, seizure, paraplegia, watershed infarct, cerebral hemorrhage, Moyamoya phenomenon, and confusion in the order of frequency. A variety of mechanisms that must be taken into account in explaining this neurologic events were proposed. The secondary hypertension and cardiac complications play an important role in causing neurologic symptoms. The formation of anastomotic networks has "Jekyll and Hyde" effect on brain both in preventing or limiting the ischemic injury and in producing some special symptoms and signs, that further widen the clinical spectrum of brain involvement.
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PMID:[Neurological manifestation of Takayasu's arteritis]. 136 36

We reported a case of juxtaglomerular cell tumor, which excessively produced renin, resulting in secondary hypertension. A 25-year-old woman complained of headache and nausea. Hypertension and elevation of plasma renin activity were found by physical and laboratory examination. US and CT showed a space occupying lesion at upper pole of the right kidney. Angiography showed a hypovascular area at the corresponding area of the right kidney. Renin-secreting renal tumor of the right kidney was diagnosed and right nephrectomy was performed. Postoperatively, blood pressure and plasma renin activity became normalized and symptoms ameliorated. The juxtaglomerular cell tumor was pathologically confirmed and localization renin in the tumor cells was shown by immunohistochemical study. Forty one cases of juxtaglomerular cell tumor have been reported, since Robertson reported the first case. We discussed the clinical and pathological characteristics of the disease in this report.
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PMID:[Renin-secreting renal tumor. A case report]. 834 32

A drug surveillance study was performed to determine the tolerance and safety of quinapril in the treatment of patients with stage 1 or 2 hypertension. The trial was noncomparative, open-label, uncontrolled, and nonrandomized. Patients with secondary hypertension, heart failure, other heart diseases, and other serious conditions were excluded. After a washout period of 2 weeks, 752 patients (316 men and 436 women) with diastolic blood pressure (DBP) between 90 and 115 mm Hg and systolic blood pressure (SBP) between 140 and 200 mm Hg were entered into the treatment phase. The mean age of patients (+/- SD) was 53.1 +/- 11.4 years. Patients initially received 10 mg/d quinapril for 4 weeks. For nonresponders, the dosage was titrated up to a maximum of 40 mg. Active treatment continued for 12 weeks. Initial blood pressures (mean +/- SD) were DBP, 102 +/- 6.1 mm Hg, and SBP, 163 +/- 14.4 mm Hg. Final blood pressures were DBP, 83 +/- 6.5 mm Hg, and SBP, 135 +/- 11.6 mm Hg. The response rate for the therapeutic goal (DBP < 90 mm Hg and SBP < 140 mm Hg, or a reduction in SBP > or = 20 mm Hg) was 67.1%; 41 patients did not complete the study. The most common adverse events were cough, headache, and dizziness; only 10 patients (1.3%) failed to complete the study because of adverse events. Quinapril, as used in current private clinical practice, is well tolerated and effective for the treatment of patients with stage 1 or 2 hypertension.
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PMID:Usefulness of low-dose, once-daily quinapril as monotherapy for patients with hypertension. 893 Apr 30

Pheochromocytomas are catecholamine-producing tumors, representing one of the most important causes of secondary hypertension. The classification of these tumors considers both sporadic and familial forms, intra- and extraadrenal localization as well as the dignity. Familial pheochromocytomas are primarily seen under the conditions of multiple endocrine neoplasia, von Hippel-Lindau disease or neurofibromatosis type 1. The list of clinical symptoms includes hypertension, which can be both continuous or intermittent, headache, tachycardia and sweating. It is most important to standardize the pre-analytical procedures, i.e. control for sampling conditions and adequate choice of parameters in plasma or urine. For screening sensitive methods will be employed (free catecholamines in 24h-urine) and for confirmation of the diagnosis, specific procedures are performed (Clonidine test, MIBG-scintigraphy). The endocrinological and biochemical procedures are completed by molecular genetic techniques in familial pheochromocytoma.
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PMID:[Clinical and endocrine diagnosis of pheochromocytoma]. 933 11

The case of secondary hypertension to pheochromocytoma in 71 year old woman is described. This woman has been made a false diagnosis of primary hypertension 10 years earlier. The primary objective of this paper was to call practitioners' attention to the necessity of penetrating diagnosis of arterial hypertension, also in elderly patients. Over-hasty diagnosis of primary arterial hypertension hampers the possibility of proper and causal treatment. Labile and paroxysmal hypertension with headache, tachycardia and sweating should alert the clinician to tumor of the adrenal medulla as well as the extra-adrenal paraganglion system (pheochromocytoma is the cause of arterial hypertension in 0.1-1.0% of all cases). Twenty four hours excretion level of vanillylmandelic acid in urine is of diagnostic relevance for patients with pheochromocytoma. The measurement which is done after elevation of blood pressure is more sensitive.
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PMID:[Secondary hypertension during a course of phaeochromocytoma in a 71-year old woman]. 943 94

Phaeochromocytoma is a rare but important cause of secondary hypertension that can prove fatal when undiagnosed. Several autopsy studies have reported that a large number of undiagnosed tumours occur during life. This review discusses the diagnostic guidelines for phaeochromocytoma. Factors such as hypertension, sustained or paroxysmal, in association with the most common symptoms of headache, sweating and palpitations, can be used to provide a suspicion of phaeochromocytoma. Although measures of plasma methoxylated catecholamines may provide a promising diagnostic method, the cornerstone for diagnosing phaeochromocytoma remains 24 h or overnight sampling of urinary free catecholamines and methoxylated catecholamines.
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PMID:[Pheochromocytoma--rare and often undiagnosed condition]. 1202 14

Many children with hypertension, particularly those with new-onset hypertension related to glomerulonephritis, organ transplantation, or other forms of secondary hypertension, require treatment with a short-acting antihypertensive in order to quickly achieve blood pressure (BP) control. We administered isradipine, a short-acting, second-generation calcium antagonist, to 72 such children. Retrospective data collection was undertaken to determine the effects of isradipine treatment. The mean age of children treated with isradipine was 74+/-55 months (mean+/-SD). Nearly all of these children had secondary hypertension and were initially treated as hospital inpatients for newly diagnosed hypertension. Mean isradipine dose was 0.36+/-0.17 mg/kg per day, with no significant variation in dose according to patient age. Isradipine was administered three times per day in most instances, but 21% of the time it was administered four times per day. An extemporaneous isradipine suspension was used in 62% of treatment courses. BP control was achieved with isradipine alone in 38 children; the remainder received isradipine in combination with additional antihypertensives. Comparison of pre-treatment BP with BP obtained 8+/-9 days later demonstrated a significant BP reduction with isradipine treatment, with a mean reduction of 14+/-13 mmHg for systolic BP and 13+/-15 mmHg for diastolic BP. There was no effect of isradipine treatment on heart rate. Adverse effects occurred in 9.5% of treatment courses, and included headache, flushing, dizziness, and tachycardia. We conclude that isradipine successfully lowers BP in hypertensive children with secondary forms of hypertension. Use of isradipine suspension allows infants and young children to be treated as readily as older children.
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PMID:Isradipine treatment of hypertension in children: a single-center experience. 1221 29

We report 3 cases of benign retroperitoneal schwannoma, of whom one presented with flank pain with hematuria, one presented with headache and secondary hypertension and one presented with recurrent renal colicky pain. Two patients were treated by open surgical excision of the tumor with nephrectomy of the corresponding side because the tumors were densely adhered to the kidney and one case treated by laparoscopic resection of the mass only. The diagnosis of schwannoma was established postoperatively after histopathological examination and immunohistochemistry. All patients are doing well in follow-up.
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PMID:Atypical presentations of benign retroperitoneal schwannoma: report of three cases with review of literature. 1630 40

We report a 40-year-old lady who presented with severe headaches, persistent microscopic haematuria and hypertension requiring anti-hypertensive medication. Investigations for secondary hypertension were all normal except for a CT scan. This indicated a complex cystic lesion, measuring 2.4 x 5 x 10 cms , arising from the right kidney. She underwent an open right partial nephrectomy. The patient made an un-eventful postoperative recovery and her blood pressure returned to normal. The mass had a smooth outer surface and the cut surface showed firm whitish tissue with a few small cysts. Microscopy showed a bland spindle cell lesion staining positively for SMA, desmin, caldesmon, focally for HMB45 amd very focally for S100. The mass was reported as a Perivascular Epitheloid Cell (PEC) lesion (PEComa) arising from the renal capsule. Perivascular Epitheloid Cell tumor (PEComa), a recently defined tumor, is extremely rare. The lesion presents a distinct muscular immunophenotype (actin+, desmin+), with co-expression of the melanogenesis marker (HMB45). This combined immunophenotype is a characteristic feature of the Perivascular Epitheloid Cell (PEC) lesions. PEComa's are usually benign, but cases have been reported in the literature which has an unfavourable outcome with metastatic dissemination. We report this case because of its rarity and also Renal Capsular PEComa should be considered as a rare cause of renal hypertension, which can be surgically cured.
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PMID:Renal capsular PEComa--a rare cause of surgically correctable renal hypertension. 1731 50


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