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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cushing's syndrome during pregnancy is most often caused by an adrenal cortical tumour; it is a rare event which bears poor foetal and maternal prognoses. We report 3 cases of adrenal cortex carcinoma diagnosed during pregnancy (after 24, 27 and 28 weeks respectively of amenorrhea) and revealed by local tumoral signs in 2 cases and by pulmonary embolism in the third. Because hair growth was moderate and weight gain as well as high blood pressure had mistakenly been attributed to the pregnant state, these clinical features of hypercortisolism has only lately been related to tumoral secretion. The hypercortisolic state was firmly established by comparing the patients' urinary cortisol levels (677, 941 and 2,167 micrograms/day) and 20-hour salivary cortisol levels (9.9, 15 and 25.3 micrograms/ml) with values obtained in women at the same stage (88 +/- 11.4 micrograms/day and 2.31 +/- 0.25 micrograms/ml). The aetiological diagnosis was made by the finding of a highly increased salivary testosterone levels (50, 34 and 95 pg/ml; normal = 8.6 +/- 4 pg/ml), and by magnetic resonance imaging which showed unilateral adrenal masses of 3, 8 and 20 cm in diameter respectively. These 3 cases illustrate the difficulty of the clinical diagnosis of hypercortisolism during pregnancy. Assessment of the unbound steroids and magnetic resonance imaging are the most useful methods for an early diagnosis, thus preventing the severe complications which may otherwise reveal this rare pathological condition.
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PMID:[Cushing syndrome during pregnancy. New diagnostic methods used in 3 cases of adrenal cortex carcinoma]. 129 77

A defect of placenta maturation has been described in hypertension of pregnancy. Plasma beta chorionic gonadotropins (beta HCG) of placental origin rise at the onset of pregnancy and reach a peak between 9 and 10 weeks of amenorrhoea. As we were making systematic assays between 14 and 20 weeks in a trisomy detection programme, we looked for differences in plasma beta HCG levels between women with pregnancy-induced arterial hypertension and pregnant women with normal blood pressure. We also studied the predictive value of such assays. Pregnancy-induced hypertension was found in 6 women in a population of 89 nulliparas and in 12 women in a population of 163 multiparas. beta HCG levels were significantly higher in women who later developed hypertension among both nulliparas (52,833 +/- 19,538 IU vs 24,499 +/- 16,485 IU) and multiparas (50,558 +/- 23,597 IU vs 20,911 +/- 11,677 IU). In nulliparas, taking 43,000 IU as threshold of pathology we found that the predictive value of beta HCG was higher than that of other tests which had gone through controlled studies (sensitivity 67 percent, specificity 91.6 percent, positive predictive value 36 percent, negative predictive value 97.4 percent, relative risk 5.4). In multiparas, taking 38,000 as threshold and combining this marker with obstetrical history it was possible to predict the occurrence of hypertension more precisely than with other markers which had gone through controlled studies (sensitivity 66.7 percent, specificity 98 percent, positive predictive value 61.4 percent, negative predictive value 97.3 percent, relative risk 8.4).
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PMID:[Plasma beta chorionic gonadotropin between 14 and 20 weeks of amenorrhea: a sign of pregnancy-related hypertension]. 145 78

A sub-capsular haematoma of the liver is a rare but very serious complication of pregnancy. We report a case of a primipara whose pregnancy was first complicated by hypertension, then by a haematoma of the liver at the 28th week of amenorrhoea. It was diagnosed because of the clinical symptoms associated with the hypertension and a pain in the right hypochondrium and nausea. The diagnosis of haematoma of the liver was made before rupture and confirmed by ultrasound of the liver and by tomodensitometry made it possible to avoid operating on the liver during the laparotomy that was carried out to terminate the pregnancy. Regular X-ray follow-ups showed that the lesion had regressed in six months. MRI investigation of the parenchyma of the liver showed no cause of the lesions. If there is even the slightest suspicion of a haematoma of the liver in pregnancy, ultrasound nowadays should be carried out because it is indispensable to make the diagnosis.
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PMID:[Sub-capsular hematoma of the liver during pregnancy: a case report]. 149 Nov 44

A phenotypic female presented initially at the age of 17 years with amenorrhoea and delay of sexual development. Karyotype was male, 46 XY, and as gonads were absent, a diagnosis of congenital anorchia was made. The patient was treated with oestrogen. At the age of 23 years, she re-presented with tall stature and hypertension. She then had normal female habitus but absent pubic and axillary hair. Re-investigation showed that sex steroids and cortisol were absent and established the diagnosis as 17 alpha-hydroxylase deficiency. Treatment with hydrocortisone rapidly corrected the hypertension. Ultrasound examination confirmed the absence of gonads but showed that a small uterus was present. Measurement of serum cortisol is important for recognition of such patients, but further measurements of sex steroids, particularly progesterone, are needed to prove the diagnosis. We have found no previous reports of absent gonads in 17 alpha-hydroxylase deficiency. The association remains unexplained.
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PMID:Deficiency of 17 alpha-hydroxylase associated with absent gonads. 156 Nov 95

The forms of administration, mechanisms of action, side effects and complications, and other aspects of female hormonal contraception are set forth in this "lesson" for medical students. Female hormonal contraception has been in use for over 30 years and is used by more than 150 million women worldwide. Oral contraceptives suppress the preovulatory peak of follicle stimulating hormone and luteinizing hormone, preventing ovulation and follicular maturation. Progestins render the cervical mucus impermeable to sperm and modify the endometrium so that it will no longer support implantation. The synthetic estrogen ethinyl estradiol is used in most combined oral contraceptives (OCs). Among the numerous progestins in use are the newer desogestrel, gestodene, and norgestimate, which have fewer androgenic and metabolic effects than did the 1st generation. the different forms of administration of hormonal methods include combined OCs, oral preparations containing low doses of progestin continuously administered or high doses continuously or discontinuously administered. Intramuscular injection of progestins and the so-called "morning after" postcoital pills are less often prescribed. The combined preparations may be monophasic, biphasic, triphasic, or sequential. Sequential preparations should be avoided because of the hyperestrogenic climate they induce. The low-dose progestin preparations are indicated for women with contraindications to synthetic estrogen. They must be taken at the same time each day and have a relatively high rate of side effects, especially ovarian and breast cysts and irregular bleeding. High-dose progestin preparations have significant metabolic effects and are indicated primarily for patients with gynecological problems such as fibromas and endometriosis. Intramuscular injection of medroxyprogesterone acetate every 3 months is effective but has the same side effects as high-dose progestins. It is indicated primarily for patients unable to control their own behavior. The hormonal methods are all highly effective in preventing pregnancy when correctly administered. Side effects may be minor problems, such as nervousness and nausea, that are usually of short duration. the more serious side effects, including modifications of lipid or carbohydrate metabolism, hemostasis, blood pressure, or hepatic functioning and cardiovascular effects, have been reduced with the new lower dosed formulations. Absolute contraindications to hormonal contraception include undiagnosed vaginal bleeding or amenorrhea, history of thromboembolic or cerebral vascular accidents, severe cardiopathy or hypertension, hyperlipidemia, hepatopathy, hormonodependent cancer, pituitary tumors, porphyria, and severe mental problems. Relative contraindications impose the need for careful monitoring and follow-up. The practitioner should be aware of the possibility of interactions between OCs and certain other drugs.
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PMID:[Hormonal contraception]. 160 74

Timely diagnosis of hypothyrosis was noted in 34% of patients only. Considerable difficulties in the diagnosis of disease were associated with an atypical course of disease in a number of patients. The authors discuss some problems of a clinical picture of hypothyrosis with arterial hypertension, sympatico-adrenal crises, polyserositis, pituitary adenoma, amenorrhea-lactorrhea, premature puberty in boys; they also discuss pathogenesis of sexual advancement of a number of pubertal features in Van Wyk-Grambooh syndrome. Hennes-Ross syndrome was identified as a separate entity.
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PMID:[Atypical clinical variants of hypothyrosis]. 178 Feb 90

Foetal well being is assumed in normally proceeding pregnancies. In pregnancies with a risk of foetal distress, the obstetrician now has the possibility of carrying out foetal cerebral hemodynamic exploration in order to reach a short-term prognosis. The brain of the foetus is a hemodynamically privileged site in cases of hypoxic foetal distress; this brain-sparing effect gives rise to Doppler velocimetric signs which are seen in animal and human foetuses. Cerebral resistance, measured in Doppler velocimetry from the resistance index R = (S.D)/S falls at the beginning of the last third of pregnancy, but remains higher than placental resistance. This is due to the considerable development of foetal brain vascularization from this time forward. Inversion of the ratio between the cerebral index (CRI) and the umbilical index (PRI) and a marked reduction of the cerebral index below the normal range demonstrates the brainsparing effect during hypoxic distress. In cases of delayed intra-uterine growth, this signs is linked to a high probability of forthcoming acute foetal distress (AFD). In hypertension of pregnancy, the fall in CRI is closely correlated with a high Caesarian rate due to AFD and a higher morbidity level and neo-natal sequelae. The prognosis for these foetuses therefore depends on their gestational age: it is good after 34 weeks of amenorrhea, but remains doubtful between 28 and 34 weeks of amenorrhea. In these cases, the administration of oxygen to the mother for 20 minutes (FLO2 = 70%, 8 l/min) constitutes a prognostic test. The foetuses whose CRI is corrected have a better prognosis than the others, if the pregnancy continues up to the change in foetal cardiac rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Contribution of cerebral doppler in the evaluation of fetal well being]. 178 Jun 22

Estimated maximum oxygen uptake of middle-aged nonelite road race entrants is around 45 to 50 ml/kg/min, which is 40 to 100% higher than values from the female general population. Endurance training, low bodyweight, and nonsmoking of runners explain part of, but not the whole, difference in aerobic capacity observed between athletes and the general population. Sedentary women can improve cardiorespiratory fitness through aerobic exercise programmes, and the women with the lowest level of initial fitness have the highest proportional improvement following training. Regularly exercising women have a significantly reduced risk of fatal and nonfatal coronary events, and low cardiorespiratory fitness is associated with an increased risk of death and nonfatal stroke. The influence of habitual running on the female blood lipid profile is not clear. Cross-sectional studies have found elevated HDL cholesterol concentrations in distance runners, but intervention studies on the effect of jogging on lipid and lipoprotein levels have provided equivocal results. A higher level of physical fitness is associated with a lower risk to subsequently develop hypertension. Experimental studies have shown that moderate intensity aerobic exercise (40 to 60% VO2max) is able to reduce blood pressure significantly in hypertensive subjects. An athletic lifestyle may be associated with a reduced risk of adult-onset diabetes mellitus (via an exercise-induced increase in insulin-sensitivity), and with a reduced risk of cancers of the reproductive system, breast, and colon. Recreational running is also correlated with better weight control. Surveys of recreational and elite distance runners show a great variability in the prevalence of secondary amenorrhoea, between 1 and 44%. Environmental factors determining the risk of amenorrhoea in runners are low body fat content, mileage, and nutritional inadequacy, with low intakes of calories, protein, and fat. Amenorrhoeic athletes in their third and fourth decade have lower vertebral bone density, which is improved after resumption of menses but does not completely reach age-specific average values. Regardless of menstrual status, the effectiveness of exercise to maintain bone mass throughout life is an important issue. Habitual exercise is associated with increased bone density of the spine both in premenopausal and postmenopausal women. Several controlled training studies suggest that postmenopausal women may at least retard their bone loss with regular aerobic exercise. Running-related injuries and complaints are common in recreational joggers, even though the reported 1-year incidence, varying between 14 and approximately 50%, depends on injury definition. Mileage and a history of previous running injury are known risk factors.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Health effects of recreational running in women. Some epidemiological and preventive aspects. 201 82

From August 1988-June 1989, 983 physicians participated in a phase IV trial by following 7759 women using the monophasic oral contraceptive (OC), Demulen 1/35 (1 mg ethynodiol diacetate and 35 ug ethinyl estradiol) to evaluate its efficacy and safety. The total number of cycles for the study stood at 21,440. In addition, the total woman-years stood at 1787. Only 6382 patients could be evaluated for safety. 4.4% of the patients had adverse reactions to the OC, but only 1.7% of all patients stopped taking it. The leading side effects included nausea (67 cases), headache (45), amenorrhea (42), emotional changes (30), breast pain (19), dysmenorrhea (12), and 11 cases of weight gain, abdominal/pelvic pain, and bloating. Of the 280 reported adverse reactions, only 87 (31%) were considered severe. The leading serious adverse reactions were depression (10) and hypertension (6). Only 5412 patients could be used to determine efficacy. The physicians initially reported 121 (2.2%) pregnancies during the study. The researchers learned that 33 of the 84 returned 2nd questionnaires (response rate, 70%) reported that the women conceived after enrollment but before taking the OC. 36 conceived while taking it, but 8 did not take it daily. Noncompliance may have contributed to pregnancy for the remaining 28 cases. Therefore the 36 confirmed pregnancies made for a failure rate of .7%. 85.7% of the pregnancies happened in the 1st 3 months of taking the OC. Either patient noncompliance or true medication failure accounted for treatment failure. Therefore it is important for physicians to instruct patients on how to take OCs correctly.
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PMID:Efficacy and safety of ethynodiol diacetate, 1 mg, with ethinyl estradiol, 35 micrograms, with an emphasis on contraceptive efficacy. A phase IV trial. 204 81

Prolactin adenomas seem rare in Dakar. Only 4 cases were confirmed by a series of 63 Intracranial Expansive Processes (ICEP) in the sella area recorded between 1972 and 1987 at Fann U.H.C Neurological and Neurosurgical Unit. These ICEP are dominated by craniopharyngiomas. From analysis of observations on four women aged between 20 and 38 years is may be concluded that: 1. Patients consult late for this amenorrhoea-galactorrhoea syndrome associated with intracranial hypertension and reductions in the field of vision. 2. On the paraclinical level: angiography reveals voluminous ICEP in the sella region with sub-sellar expansion; dosage with prolactinemia was only possible in 2 cases (of which 1 was post operational), which underlines the difficulties of carrying out this examination and its high cost despite its obvious usefulness in diagnosis and therapeutic supervision. 3. All operations were accompanied by histological study of the operational part which confirmed prolactinemia. Bromocriptine is the best medicine to be employed before or after the operation, and, in one case, allowed preoperational prolactinaemia to be reduced. 4. Classical X-rays of the skull centred on the sella turcica, and prolactinaemia medication for any amenorrhoea-galactorrhoea syndrome, should lead to a better understanding of the incidence of prolactin adenomas in this area.
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PMID:[Prolactin adenomas in Dakar]. 213 89


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