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

Clinical features of epinephrine release led to the finding of spontaneously elevated plasma epinephrine concentrations in five patients, in four of whom plasma norepinephrine concentrations were normal. Adrenal medullary hyperplasia was suspected in one patient, whose first cousin had multiple endocrine neoplasia type IIa, and in two others, all of whom have experienced relief from symptoms during propranolol or atenolol administration. The other two patients had unilateral adrenal cysts, with negative metaiodobenzylguanidine scans and no histological evidence of pheochromocytoma, but complete relief of symptoms by excision of the cysts. In one patient, Cushing's syndrome and associated hypertension, diabetes, and ischemic finger-tip ulceration all disappeared after surgery. It is concluded that spontaneous hyperepinephrinemic manifestations can be received by beta-blockers or, when an adrenal mass is present, by unilateral adrenalectomy even when the metalodobenzylguanidine test result is negative.
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PMID:Primary hyperepinephrinemia in patients without pheochromocytoma. 236 52

Two cases of familial multiple endocrine neoplasia syndrome (MEN) are reported. Case 1. A 31-year-old woman began to have repeated attacks of coma in 1970. Blood examination showed fasting sugar as low as 2.05 mmol/L (37 mg/dl). Her disease was cured after the removal of two insulinomas in 1972. However, coma occurred again in 1982. Examination revealed the ratio of concentrations of serum insulin and sugar being more than 0.3. Another operation with removal of 19 insulinomas were performed in our hospital in 1985. After operation, the level of blood sugar returned to normal. Her father had suffered from Zollinger-Ellison Syndrome; the entire stomach and a part of pancreas were removed in 1967. So we examined her brother. His serum calcium level was 2.5-2.9 mmol/L (10.0-11.6 mg/dl) and plasma iPTH level 49.5-115.5 ng/L (normal value 21.4 +/- 7.7 ng/L n = 71). The high level of iPTH could not be suppressed by calcium load test. The total of two and a half of the remaining two parathyroid glands were removed. Pathology confirmed hyperplasia of parathyroid glands. The levels of serum calcium and iPTH returned to normal after operation. Case 2. A 25-year-old woman suffered from hypertension at the age of ten. Adrenal tumor with pheochromocytoma (2 x 2 x 1.5 cm3) was diagnosed and removed at that time. She complained of intermittent coma for 10 months and was thus admitted to our hospital in Nov. 1984. The level of blood sugar was 1.5-3.8 mmol/L (26-67 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[2 cases of familial multiple endocrine neoplasia syndrome]. 257 47

Diffuse, alimentary tract ganglioneuromatosis-lipomatosis, bilateral adrenal myelolipomas, pancreatic telangiectasias, and a multinodular thyroid goiter were found at autopsy in a 56-year-old, white male with a history of insulin-dependent diabetes, hypertension, peptic ulcer, and remote cerebral infarction. The degree of atherosclerosis, arterionephrosclerosis, and cardiac disease found at autopsy did not correlate with the patient's history or his sudden death. The typical features of the multiple endocrine neoplasia syndrome, type II-B, were not identified. The findings in this patient may represent a variant of the multiple endocrine neoplasia complex, or a separate, previously unrecognized syndrome.
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PMID:Alimentary tract ganglioneuromatosis-lipomatosis, adrenal myelolipomas, pancreatic telangiectasias, and multinodular thyroid goiter. A possible neuroendocrine syndrome. 286 Aug 6

A 31-year old woman was admitted to our clinic complaining of high blood pressure, dizziness, constipation, mental irritability and weight loss. The physical examination revealed goiter in her neck. The plasma levels of norepinephrine and epinephrine were 3.45 and 0.76 ng/ml, respectively. Urinary excretion of norepinephrine was 1 mg and epinephrine was 32.2 micrograms/24-hours. The examination by radiography and radioactive isotope revealed a tumor in the left adrenal region and another in the left lower lobe of the thyroid. After the operations, pheochromocytoma and papillary adenocarcinoma of the thyroid gland were recognized pathologically. However, 17 months later, the recurrence of pheochromocytoma in the contralateral adrenal region was discovered and removed. Although the co-existence of bilateral pheochromocytoma and papillary adenocarcinoma of the thyroid gland is not one of multiple endocrine neoplasia, to the best of our knowledge, only 7 such cases have been reported in the published literature.
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PMID:Bilateral pheochromocytoma associated with papillary adenocarcinoma of the thyroid gland; report of an unusual case. 286 43

Recent information has shed a new light on the control of parathyroid hormone (PTH) secretion by calcium and 1,25-(OH)2D. These new data have permitted a better understanding of the pathogenesis and management of secondary hyperparathyroidism in end-stage renal disease. Emerging evidence has suggested a role for secondary hyperparathyroidism in the development of certain forms of hypertension and osteoporosis. Recent insights have been obtained regarding the occurrence of secondary hyperparathyroidism in obese and black subjects, in patients with multiple endocrine neoplasia type I, and in manic-depressive patients receiving lithium therapy. This review examines some of these recent gains in knowledge concerning secondary hyperparathyroidism, as well as their clinical implications.
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PMID:Update on secondary forms of hyperparathyroidism. 288 9

A 26-year-old male presented with the symptoms and signs of acute congestive heart failure and hypertension. The left ventricle was shown to be thickened and displayed reversible hypokinesia. Further investigations revealed the underlying pathology of a phaeochromocytoma, bilateral medullary thyroid carcinoma (MTC), parathyroid adenoma and macro-prolactinoma. There was a family history of MTC. The echocardiographic features of catecholamine-induced cardiomyopathy were important in this diagnosis. Our research revealed no previous report of Sipple's syndrome associated with a macroprolactinoma. This case, along with the other 13 reports of mixed (type I and II) multiple endocrine neoplasia (MEN), are not within the classical subsets of MEN.
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PMID:Sipple's syndrome associated with a large prolactinoma. 289 62

Although pheochromocytoma is an uncommon cause of secondary hypertension, it is also a curable form of hypertension. With proper treatment, the outlook for patients with pheochromocytoma is excellent. If undiagnosed or untreated, pheochromocytoma causes serious complications and death. The key to reaching the diagnosis is a high index of suspicion coupled with careful clinical evaluation and laboratory testing. Our ability to diagnose and localize pheochromocytoma has improved vastly, owing largely to the modern biochemical and radiologic techniques. Despite this, a number of pheochromocytomas remain undiagnosed only to be uncovered after a serious complication or at postmortem. The diverse manifestations and problems presented by patients with pheochromocytoma can be managed only with combined medical and surgical expertise, with assistance from our colleagues from the radiology and anesthesiology disciplines. Although sporadic pheochromocytoma is the most common form of presentation, the overall clinical picture may depend on the subset of affected individual--childhood, pregnancy, associated MEN, and neurocutaneous syndromes. Fortunately, more than 90 per cent of all pheochromocytomas originate in the adrenal gland, but the tumor can occur at any site in the sympathetic chain. The spectrum of clinical manifestations is so wide that a pheochromocytoma may mimic a variety of common disorders. It is as challenging to diagnose what is not a pheochromocytoma as it is to confirm its diagnosis. Surgical removal of pheochromocytoma is the treatment of choice. With proper preoperative medical management aimed at blocking the effects of catecholamines, operative mortality should be close to zero. For patients with inoperable, malignant, recurrent, or multicentric pheochromocytomas, chronic medical therapy is indicated in the form of alpha- and/or beta-blockade or inhibition of catecholamine synthesis with alpha-methyl-para-tyrosine. An understanding of the pathophysiology and natural course is vital to the rational management of patients with pheochromocytoma.
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PMID:Pheochromocytoma. 306 44

Thirty-two histopathologically confirmed pheochromocytomas were diagnosed at Henry Ford Hospital, Detroit, between 1951 and 1982. Eleven (34%) of these cases were clinically unsuspected exhibiting none of the typical symptoms of palpitation, diaphoresis, or headache, and only five were hypertensive. These pheochromocytomas may be discovered during computed tomography of the abdomen while evaluating multiple endocrine neoplasia, abdominal pain, and abdominal masses, or they may present at autopsy, at surgery, or as a mass lesion without paroxysmal symptoms or hypertension. Before 1962, 53% of these tumors were undiagnosed before surgery or autopsy; however, since 1962 only 18% of pheochromocytomas have remained clinically unsuspected. By maintaining a higher index of suspicion and using newer biochemical and imaging techniques, the incidence of clinically unsuspected pheochromocytomas should be reduced.
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PMID:Clinically unsuspected pheochromocytomas. Experience at Henry Ford Hospital and a review of the literature. 394 65

In a series of 53 pheochromocytoma patients operated on at Sahlgren's Hospital during 1956-82, a positive linear correlation is established between the 24-hour urinary excretion of vanilmandelic acid (mumol/24 h) and tumour mass (g). A similar correlation was found between the excretion of metanephrines and tumour mass in 33 subjects. The patients were subgrouped according to their type of hypertension. A statistically significant correlation between vanilmandelic acid excretion and tumour mass persisted in groups IA (sustained hypertension without attacks), IB (sustained hypertension with attacks), and II (paroxysmal hypertension) but not in group III (miscellaneous patients). There was also a correlation between metanephrine excretion and tumour mass in groups IB (n = 8) and II (n = 12). In 10 patients with the syndrome of multiple endocrine neoplasia, a positive correlation was found between tumour mass and the excretion of vanilmandelic acid, metanephrines and adrenaline.
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PMID:Positive correlation between urinary excretion of catecholamine metabolites and tumour mass in pheochromocytoma. Results in patients with sustained and paroxysmal hypertension and multiple endocrine neoplasia. 397 35

A case of multiple endocrine adenopathy type I associated with a solitary carcinoid tumour is described. During anaesthesia and characteristic syndrome consisting of hypertension, tachycardia and flushing occurred. The possible mechanism for this are discussed.
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PMID:Severe hypertension and flushing in a patient with a non-metastatic carcinoid tumour. Hypertension and flushing with a solitary carcinoid tumour. 612 78


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