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

Although some psychiatric patients may have a disorder of hypothalamic-pituitary-adrenal (HPA) function equal in character and severity to that noted in milder cases of Cushing's disease, it is generally accepted that such patients do not show Cushingoid stigmata. This conclusion, however, appears to be based more on clinical observation than on the results of formal scientific investigation. Since some depressed patients appear to overlap with Cushing's disease patients in incidence of such signs and symptoms as amenorrhea, hypertension, sleep disturbance, and insulin resistance, we were interested in examining whether a group of psychiatric patients showing evidence of marked nonsuppression might not also show physiological changes consonant with the effect of glucocorticoid excess. Nonsuppressors selected on this basis differed slightly from a matched suppressor control group on percentage of polyneutrophils and lymphocytes in blood. A discriminant function constructed from blood sample measurements of 12 factors and systolic/diastolic blood pressure successfully predicted suppressor or nonsuppressor status in the original and in an independent group of psychiatric patients. A comparison group of Cushing's disease patients was also successfully reclassified on the basis of the discriminant function. These data are interpreted as evidence for a subtle physiological effect of HPA dysregulation and suggest that behavioral symptom complexes may be similarly shaped by changes in this neuroendocrine system. The long-term functional significance of such changes is at present speculative.
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PMID:Evidence for physiological effects of hypercortisolemia in psychiatric patients. 385 48

A new ultrasonic method based on X-ray concepts for depicting prenatally developed centers in the tarsal bones, calcaneus and talus, as well as and especially in the epiphysis centers of the fetal knee joint is described. Investigations of average collectives show that the center in the calcaneus becomes visible during the 24th week of pregnancy, on the average, whereas the center in the talus becomes visible during the 26th week after begin of amenorrhea. The growth charts of both these tarsal centers demonstrate almost linear growth until parturition, the very slight increase per week, however, limits the possibilities for their use in determining the period of gestation. The epiphysis center in the distal femur becomes visible by ultrasonic methods during the 32nd week of pregnancy, on the average, the center in the proximal tibia appears later, during the 37th week after amenorrhea begins. Both epiphysis centers show an almost linear increase in size from the time they first appear; the center in the femur, however, has a growth chart that shows levelling off after the 38th week of pregnancy. The differences between X-ray and ultrasonic representation, which become evident upon comparing growth charts as well as in a separate and direct comparison are shown to be due, through the results of a parallel histological study, to an increase in density of the cartilage matrix prior to ossification. Of the fetal factors which were investigated only the weight and length of the child show a slight, and for practical purposes negligable influence on the size of the epiphysis centers, whereby only the results showing that the femur centers tend to be larger when the child is heavier and longer appear significant. Neither sex nor maternal factors influence the size of the visible epiphysis centers in any way. A slight modification in the case of diabetics and pregnancy induced hypertension patients seems to most likely be due to the macrosomal and retarded children occurring in these groups. None of the factors investigated effect a significant difference in the ultrasonic development or time of appearance of the epiphysis centers. In view of the fact that growth charts show levelling off and of the wider biological scattering range of all parameters currently used to determine the duration of gestation during the last trimenon, making use of this new ultrasonic method with its double advantage - the first appearance of the centers during the last quarter of pregnancy as well as the following near-linear increase in size - seems to suggest itself.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Sonographic detection of fetal epiphyseal centers--an additional parameter for determining delivery date]. 389 Mar 74

This paper presents a state-of-the-art review of oral contraceptives (OCs), termed one of the epochal developments of modern times. OCs have had both direct and indirect influences on moral, social, and cultural values and on the interaction of population resources and the environment. In recent years there has been a trend away from OC use because of increased mortality rates, especially in women over 35 years of age and smokers. However, epidemiologic studies have indicated that the incidence of death from cardiovascular disease, thromboembolic disease, and stroke was greatly reduced when newer preparations with lower steroidal doses became available. The reduction of the estrogen content from 150 mcg of ethinyl estradiol-3-methylether to 30-35 mcg of ethinyl estradiol and of the progestin component from 10 mg of norethindrone to 1 mg or less has not interefered with effective conception control. The progestin component of the pill was linked to high blood pressure, lipid changes, and cardiovascular changes with an unfavorable impact on arterial disease. Although many insist that the question of whether OCs cause or predispose to cardiovascular problems cannot be answered at this time, the potential risks involved in OC use are generally regarded to be outweighed by the benefits. Reductions in OC dosages have also reduced the incidence of galactorrhea, amenorrhea, and on-pill amenorrhea. New triphasic formulations that more closely imitate the hormonal fluctuations of the menstrual cycle are considered to hold much promise in terms of safety and effectiveness.
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PMID:Oral contraceptives: the state of the art. 391 70

The combined estrogen/progestogen oral contraceptive (OC) is the most common form of contraception that is used by sexually active women who are between the ages of 15-35 years. Serious side-effects are infrequent, and the failure rate is exceedingly low. The major side-effects of OC administration are seen in 4 distinct areas: subsequent fertility; the cardiovascular system; metabolic effects; and malignancy. Approximately 1% of women experience persistent amenorrhea after they cease to take OCs, but considerable doubt exists as to whether this is purely an effect of OC or is due to other factors such as weight change, excessive exercise, or psychological disturbances. The major cardiovascular problems are those of hormone-induced hypertension, deep vein thrombosis, coronary artery disease, and stroke. It is not possible to predict which patients will develop hypertension while taking OCs, and all patients should have their blood pressure checked within 6 months of starting OC use and then approximately once a year. There is little doubt that the increased risk of deep vein thrombosis that was observed in women using OCs in the 1960s was related to the high estrogen content of the early OCs. As the dose of estrogen has been reduced progressively, the incidence of deep vein thrombosis has decliined. It is now a rare occurrence in clinical practice. The association between coronary artery disease and cerebrovascular disease and OCs has been known for the last 5-6 years. It is evident that the risk is increased in women who smoke, especially when they are over age 35. The main predictor of the risk of coronary artery disease and stroke appears to be a reduction of high-density lipoprotein (HDL) cholesterol levels. In the combined OC preparations, the action of 1 steroid is variably balanced by the other, and the overall effect on HDL cholesterol levels is often minimal. The major metabolic side-effects concern the changes in gluclose tolerance and an apparently increased risk of gall bladder disease. Low-dose OCS have virtually no effect on glucose status and, providing that diabetic patients are supervised adequately and have no evidence of vascular disease, low-dose OC preparations can be used safely. The question of whether the steroidal components of OCs may have initiating or promoting effects in relation to the development of cancer continues to be debated. The major concern recently is in relation to breast and cervical malignancies.
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PMID:Beneficial and adverse side-effects of hormonal contraception. 394 15

This discussion identifies the risks and benefits of each of the hormonal methods of contraception -- combined estrogen-progesterone oral contraceptive (OCs), progestogen-only pills, and depot progestogen injections. It also explains the use of a profile of risk factors in considering the appropriate prescription for each individual in relation to her contraceptive needs. Information regarding medical risks has come from the consideration of mortality rates in large cohort studies. Looking at categories of the causes of 249 deaths in ever-users of the pill and controls, Layde and colleagues were able to show that there was an excess mortality in the pill group of 40% and that the extra risk was concentrated in cardiovascular causes: myocardial infarctions, cerebral thrombosis, and cerebral hemorrhage constituted the largest proportions. A small proportion of combined OC users may develop clinical hypertension but more suffer a reduction in the high-density lipoprotein (HDL) cholesterol fraction of the blood lipids. Both of these effects tend to increase the risk of cardiovascular complications and both are positively related to the dose of the progestogen components. In prescribing combined OCs, attention needs to be paid to further moves away from the norm towards the extremes: the presence of cardiovascular risk factors and the use of certain longterm medications or the presumptive designation as a "rapid metabolizer." An analysis of progestogen only pill (POP) users in the Oxford-Family Planning Association study confirmed the reasonably low rates of accidental pregnancy in POP users. There is a marked reduction with increasing age, and it is significant that many prescribers are now giving POP to older women for whom combined OCs are contraindicated because of cardiovascular risks. It also seems reasonable to use them in women with some medical disorders, for example, recurrent pulmonary embolism, hypertension, and diabetes. Initially, depot injections of progesterone were developed to provide a long-acting or sustained-release type of drug administration to assist users of the progestogen-only method which, unlike combined OCs, does not make use of regular drug-free intervals. In practice it has been found that the effectiveness against pregnancy is enhanced and the side-effects are increased in giving progestogen by depot injection. The 2 preparations currently licensed in Britain are Depo-Provera (medroxyprogesterone acetate) and Noristerat (norethisterone enanthate). In some cases proper and clear information may not have been given to the patient and proper consent not obtained before giving the drug. This problem is magnified because of the occurrence in some women of disturbed bleeding patterns, especially if given immediately after childbirth or an abortion. Also, in a small proportion of users anovulatory amenorrhea may supervene for some months or even as long as 2 years following depot injection.
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PMID:Hormonal contraceptive methods. 401 68

490 women who used Stediril (.5 mg norgestrel and .05 mg ethinyl estradiol, combined) for a total of 5600 cycles or 466 woman-years over a 3 year period are presented. They all took the pills primairly for contraception; most were 20-30 years old, and took Stediril 3-6 months. Some other indications were 119 cases of menstrual irregularity, 15 of spaniomenorrhea, 14 of premenstrual syndrome and 3 of acne, all relieved. 46 of 50 cases of menorrhagia, 83 of 89 of dysmenorrhea and 32 of 34 with pelvic pain were relieved. Withdrawal bleeding was usually less than before and tended to diminish with time. There were 46 women with nausea, 3 of whom stopped Stediril. Migraines sometimes a ppeared, sometimes disappeared, but often occurred regularly on the first day between pill cycles. 52 women complained of breast congestion for the first time. Weight rose in 2301, fell in 98 and stayed constant in 134 after 3 months: weight was easily controlled with diet and appetite supressant drugs. No hypertension was observed. There were 19 single cycles of amenorrhea, several cases of persistant amenorrhea and 4 cases of amenorrhea after stopping. 2-3% of cycles were marked by metrorrhagia; 63 women had spotting, 8 had significant metrorrhagia; 7 had metrorrhagia followed by withdrawal bleeding in that cycle. 1 woman had a thromboembolism of the left leg after 2 pill cycles during which she gained 3 kg. There was 1 pregnancy due to irregular pill use.
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PMID:[Clinical study of an estro-progestative association in low doses. Experience of 3 years (490 patients-5600 cycles)]. 426 90

The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol or mestranol) and progestogen (norethindrone, norethynodrel, ethynodiol diacetate, or norgestrel), are of 3 types: combination, sequential, and minidose progestogen alone. The most effective contraceptive available is the combined oral pill with a pregnancy rate of less than .2 % per 100 women after 1 year. Contraceptive action is exerted primarily through inhibition of ovulation and secondarily by alterations in cervical mucus, endometrial glands, the ovary, and in the oviduct and uterine muscle. In comparison, sequential oral contraceptives are less effective with greater side effects, and should only be used in women with amenorrhea. Effects of oral contraceptives other than contraception include those on the (1) the primary targets of the female reproductive system, (2) on other endocrine oragans and (3) on the remainder of the body. In the first group, changes may include transitory stromal fibrosis in the ovary, enlarged fibromyomata, intermenstrual bleeding or amenorrhea, increased amount of cervical mucus, polypoid hyperplasia of the endocervical glands, breast tenderness, and changes in lactation. Changes in the second category which may occur affect the adrenal glands, hypothalamus, the thyroid (increased thyroid-binding globulin), and pancreas (alterations in glucose metabolism). Effects on the rest of the body may include increase in serum lipids and changed atherogenic index, abnormalities in liver function, thromboembolism (incidence in oral contraceptive users 4.4 times that in non-users), melasma, alterations in the central nervous system with increased incidence of cerebral vascular accidents, hypertension, and increased body weight. Absolute contraindications to oral contraceptive therapy include cancer of the breast and uterus, pregnancy, active liver disease, hyperlipidemia, and history of gestational diabetes, thromboembolic phenomena or coronary artery disease. Relative contraindications include depression, migraine, myomata of the uterus, hypertension, epilipsy, oligomenorrhea and amenorrhea. Reliable epidemiologic data on IUDs from the Cooperative Statistical Program indicated first year pregnancy rate of 2.5%. Problems with the IUD include: 1) pregnancy with device in situ, which is associated with a higher incidence of spontaneous abortion; 2) ectopic pregnancy, which is prevented at a rate of only 90% compared with intrauterine pregnancies prevented in 97-98%; and 3) expulsions (20% of which are unnoticed), the expulsion rate being higher with decreasing age and parity, higher in the first than second year of use, and higher with smaller than larger devices. A major problem is discontinuation for medical reasons (15% rate in the first year), mainly bleeding and pain. Perforation, another serious complication, occurs initially at time of insertion with an incidence of 1 per 2500 insertions for the loop. IUDs were found to produce a sterile inflammatory tissue reaction, which is postulated as the primary causative factor for their contraceptive effect in humans.
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PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

943 cases of side effects reported in the years 1966-1970 by women who used oral contraceptives are analyzed. 74% of the women used oral contraceptives as the only form of contraception during this period. Thromboemboism, jaundice, and amenorrhea were the most frequent complications of contraceptive use. 368 cases of thromboembolism were reported, with a mortality rate of 9/100,000 oral contraceptive users per year. 74% of the thromboembolic disorders were reported within the 1st year of oral contraceptive use, and the frequency of such disorders increased with the age of the users. 58% of the 191 cases of jaundice were reported within the first 3 months of use, 79% within the 1st year of oral contraceptive use. The frequency of jaundice was 1 case/4000 oral contraceptive users, and jaundice occurred most often in the 20-29 year age group. Women who suffer from jaundice during pregnancy are more likely to suffer from it during contraceptive use. Of the 104 cases of amenorrhea, only 36% had been reported within the 1st year of contraceptive use, and was most frequent in the 20-29 year age group. Sensitivity of the hypothalamus to exogenous stimuli is suspected as the cause of this amenorrhea. It is noted that side effects are not reported as diligently as is to be desired, i.e., although only 14 cases of depression were reported, it is believed that 20-30% of oral contraceptives users suffer from depression. Weight gain, hypoglycemia, diabetes, and hypertension are other disorders whose connection with oral contraceptive use is hard to determine. Information on the long-term complications is scarce yet is needed to complete the overall view of the side effects of oral contraceptive use.
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PMID:[Side effects of oral contraceptives]. 513 Mar 26

20-30 million women use oral contraceptives. The estrogen component, either ethinyl estradiol or mestranol, inhibits the release of the ovum and affects the cervical secretions, the endometrium, the ovaries, and the Fallopian tubes. The gestagen component is derived from 19-nortestosterone or 17-hydroxyprogesterone, and the metabolism of the gestagen component is not fully known. Disposition to thrombosis, liver illness, diabetes, hypertension, amenorrhea, oligo menorrhea, or tumorous changes in the uterus or breasts should not use oral contraceptives. Menstrual disturbances and endometriosis can be controlled by the use of oral contraceptives. Urine samples, blood pressure, and weight should be monitored during oral contraceptive use.
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PMID:[What do oral contraceptives do? What are oral contraceptives?]. 513 57

Endocrine function was studied in a 24 year old female with lipoatrophic diabetes (LD). Baseline endocrine studies (serum triglycerides: 2600 mg/dl) demonstrated hyperprolactinemia (serum prolactin 51 ng/ml), increased ACTH levels, absence of suppression of ACTH to a high dose of dexamethasone which suppressed serum cortisol normally and, hyperresponsiveness of TSH to stimulation with TRH. Thyroid hormone levels (total and free fraction) were essentially normal. Major metabolites of thyroid hormone (T3, rT3, 3, 3'-T2, and 3', 5'-T2) were also normal and exhibited a normal response to the administration of L-thyroxine and propylthiouracil. Exchange of 84% of the patient's plasma resulted in a decrease in serum triglycerides (700 mg/dl) which was followed by a rebound to the original level in seven days. After the sixth plasmapheresis serum triglycerides stabilized at less than 1000 mg/dl. Plasmapheresis was associated with the appearance of amenorrhea and galactorrhea; also hypertension and proliferative retinopathy developed during this therapy. Repeat endocrine function studies (serum triglycerides: 700 mg/dl) showed a further rise in serum prolactin (greater than 160 ng/ml), persistence of abnormal ACTH secretion and normalization of TSH responsiveness. Lipoatrophic diabetes is associated with abnormal central endocrine function but appropriate peripheral target gland secretion. A course of plasmapheresis improves the hypertriglyceridemia but not the endocrine dysfunction. In this patient with LD the most important side effect of plasmapheresis was the development of cardiovascular complications.
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PMID:Lipoatrophic diabetes: endocrine dysfunction and the response to control hypertriglyceridemia. 628 8


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