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

Urines from patients with hypertension and elevated aldosterone levels, i.e. primary aldosteronism due to adrenal adenoma or hyperplasia or carcinoma were extracted, paper chromatographed and thereafter chromatographed repeatedly with normal phase and repeatedly with reversed phase HPLC systems in an attempt to find new metabolites of aldosterone. Specific 3 alpha-hydroxy-5 beta-tetrahydroaldosterone antiserum was used in a radioimmunoassay system to detect possible aldosterone metabolites in the HPLC fractions after each isolation step. The immunoactive HPLC fractions were derivatized and analysed by GC-MS. A relatively nonpolar compound, 11 beta:18(S),18:20 alpha-diepoxy-5 beta-pregnan-3 alpha-ol, was isolated and identified in this manner. This material was originally described by Kelly et al., in 1962 after loading human subjects with huge amounts (25-160 mg) of exogenous aldosterone. This material has not yet been described from endogenously produced aldosterone. Very small amounts, if any, were similarly isolated from the urine of a control subject. Therefore, this compound could prove to be a new marker for hypertension due to hyper-production of aldosterone.
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PMID:HPLC isolation and GC-MS characterization of a compound strongly cross reacting with tetrahydroaldosterone antiserum. 374 16

A 47-year-old woman was cured of hypokalaemia and recurrent paralysis by the excision of an adrenal adenoma. Hypertension was initially ameliorated but was not cured. Suppression of plasma renin activity was abolished when the adenoma was excised. Repeated measurement of plasma corticosteroids before operation showed a slight increase in aldosterone and normal plasma concentrations of deoxycorticosterone, corticosterone, and cortisol. No evidence of excess mineralocorticoid was obtained from measurement of the electrolyte composition of colonic fluid or of rectal potential difference, although both these variables responded normally to salt depletion and exogenous aldosterone. The diagnostic importance of the paradoxically normal colonic measurements is emphasized and the possibility is considered that the adenoma may have secreted an unidentified hormone.
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PMID:Periodic hypokalaemic paralysis, adrenal adenoma, and normal colonic transport of sodium and potassium. 471 16

Two female patients, 54 and 34 years old, each presented with an adrenal adenoma and hypertension. Blood pressure fell after removal of the tumors. The first patient had high urinary 18-hydroxycorticosterone and periodically elevated 18-hydroxy-deoxycorticosterone excretions. The second patient had elevated 18-hydroxycorticosterone and free cortisol excretions. Urinary aldosterone, aldosterone metabolites and plasma aldosterone were not increased. Plasma renin activity was suppressed and serum potassium levels were normal. After surgery, no elevated steroid values were found. Elevated 18-hydroxycorticosterone excretion may be an indicator of yet unknown hypertensinogenic mechanisms. The role of 18-hydroxycorticosterone in the etiology of hypertension is still unknown.
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PMID:Increased excretion of 18-hydroxycorticosterone in patients with adrenal adenomas and hypertension. 629 15

There is clinical, biochemical, and pathological evidence that idiopathic aldosteronism is part of a continuum which includes low-renin and normal-renin essential hypertension. In a retrospective statistical study, 89 patients with essential hypertension have been compared with 22 cases of idiopathic aldosteronism and 34 cases of aldosterone-secreting adrenal adenomas. Measurements of serum sodium, potassium, bicarbonate, and plasma angiotensin II concentrations and estimates of exchangeable sodium and potassium were obtained for individual patients. By using various combinations of these biochemical variables, a statistic, the Mahalanobis distance, was described for each of the three populations, essential hypertension, idiopathic aldosteronism, and adrenal adenomas. For each combination of variables, the distribution of the idiopathic aldosteronism group resembled that of the essential hypertension group more closely than that of the aldosterone-secreting adrenal adenoma group. Thus, the use of this statistical technique provides further evidence of the similarity of essential hypertension and idiopathic aldosteronism.
Hypertension
PMID:Similarity of idiopathic aldosteronism and essential hypertension. A statistical comparison. 633 18

Two patients with both primary hyperparathyroidism and primary hyperaldosteronism are described. Each presented with high blood pressure and a history of renal calculi. Mild hypercalcaemia was associated with raised plasma parathyroid hormone concentrations and a parathyroid adenoma was excised from each. Both patients also had hypokalaemia, hyperaldosteronism and low plasma renin concentrations. Quadric analysis, adrenal vein plasma aldosterone concentrations, adrenal venography and CT scanning all suggested an adrenal adenoma in each patient. This suspicion was confirmed at operation in one patient; the other patient is unfit for adrenal surgery but her blood pressure and plasma potassium concentration have remained within the normal range during prolonged treatment with either spironolactone or amiloride. Because of this unusual association a search was made for parathyroid hormone excess in patients with primary hyperaldosteronism and for aldosterone excess in primary hyperparathyroidism. None was found.
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PMID:Primary hyperparathyroidism associated with primary hyperaldosteronism. 634 7

In 3 patients with longstanding hypertension and spontaneous or diuretic-induced hypokalemia, the diagnosis of primary aldosteronism was established by the dual criteria of non-suppressible plasma aldosterone level and suppressed plasma renin activity. Preoperative studies of the etiology for the hyperaldosteronism using the postural plasma aldosterone test and adrenal venous steroid measurements gave conflicting results. On the basis of the differential adrenal venous steroid content, which suggested an unilateral adrenal source for the aldosterone hypersecretion, presumed to be adrenal adenoma, each patient was operated upon. In each case the excised adrenal revealed adenomatous or macronodular hyperplasia. Reinvestigation of the patients 3 to 12 months after the adrenalectomy showed that the dynamics of the renin-aldosterone axis was now restored to the normal state even though the patients remained hypertensive. These findings indicate that unilateral hypersecretion of aldosterone associated with adrenal hyperplasia can occur in some patients with primary aldosteronism simulating that due to an aldosteronoma. Such observations also raise questions about the pathogenesis of the adrenal hyperplasia and seem to add further complexity to the evaluation of patients with hyperaldosteronism.
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PMID:Unilateral hypersecretion of aldosterone associated with adrenal hyperplasia as a cause of primary aldosteronism. 636 63

A 56 year old man presented with hypertension, hypokalemia and depressed plasma renin activity. Plasma aldosterone was normal, but was considered inappropriate in the presence of hypokalemia. An adrenal scan showed unilateral uptake of 131I-cholesterol and a presumptive diagnosis of adrenal adenoma was made. At surgery, no adenoma was found. Instead, the adrenal was atrophic, and in this case also contained caseating granulomas. Postoperative plasma aldosterone values were consistently normal and adrenocortical insufficiency was ruled out. On requestioning, the patient admitted long-term topical use of a skin cream containing 9-alpha-fluorprednisolone. Withdrawal of the fluorprednisolone cream led to normalization of blood pressure and serum potassium, and on renewed contact with the drug, hypertension and hypokalemia reappeared. The patient is now normotensive and normokalemic after permanent discontinuation of the cream. Topical cutaneous application of 9-alpha-fluorprednisolone can induce a syndrome closely mimicking primary aldosteronism. A high degree of suspicion and adequate history taking are critical for the appropriate management of such patients and the avoidance of unnecessary or dangerous procedures.
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PMID:Pseudoprimary aldosteronism from the topical application of 9-alpha-fluorprednisolone to the skin. 639 85

32 patients with primary aldosteronism due to adrenal adenoma were studied to elucidate the relationship between blood pressure (BP) and renal functions before and after the removal of aldosteronoma. The relationship between either BP or renal functions and the structural changes of the renal biopsy specimens obtained at the operation was also examined. Renal function studies included serum urea nitrogen (BUN), creatinine, creatinine clearance (Ccr), phenolsulfonphthalein (PSP) test, and urine concentration test (max SG). Renal plasma flow (RPF), renal blood flow, and filtration fraction (FF) were measured. Serum sodium was significantly decreased and potassium was increased after the removal of the aldosteronomas. The levels of BUN, Ccr, PSP, and max SG were not significantly correlated to either pre- or postoperative BP levels, and to the improvement of hypertension after the operation. On the other hand, BP was significantly correlated with RPF and FF before surgery. Furthermore, the postoperative improvement of hypertension was correlated with the decrease of FF and the increase of hematocrit after surgery. The influence of duration of preoperative hypertension on BP response after adrenalectomy was not significant in the present study. The higher the BP level, the more marked histological changes were found. But, there was no relationship between renal functions and histological changes of renal biopsy specimens. The results indicate that RPF may participate in the hypertension of primary aldosteronism and that the BP level after surgery may be predicted by examination of the pathological changes present in the kidney.
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PMID:Relationship between postoperative blood pressure change and renal pathophysiology in primary aldosteronism. 650 59

Thromboembolic events are thought to occur with increased frequency in Cushing's syndrome due to the predisposing factors, obesity, hypertension, a raised haematocrit and major surgery plus a 'hypercoagulable state'. To examine this postulate further we have studied 43 patients with Cushing's syndrome retrospectively and 10 patients prospectively to determine the incidence of arterial and venous thrombosis, both spontaneous and post-operative. Arterial events were noted in four cases (9%) and deep vein thrombosis or pulmonary thromboembolism (PTE) occurred in six cases (11%). Post-operative PTE occurred in 2.7% of all operations. These vascular complications tended to occur in the older patients with Cushing's syndrome. In our series, clinically significant thromboembolic episodes appear no more common than expected and the indications for prophylactic anticoagulation (the older and more obese patients) may not be different from other patients undergoing major surgery. An incidental finding was of a greater frequency of hypertension in Cushing's patients due to an adrenal adenoma.
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PMID:Thromboembolic complications in Cushing's syndrome. 662 1

The furosemid test followed by PRA evaluation in 83 hypertensive patients has revealed 22% of patients highly sensitive to diuretics. Their treatment with diuretics alone during 6-12 months had a good antihypertensive effect. In 42% of patients antihypertensive effect was achieved by continuous long-term treatment with diuretics supplemented periodically with short-term courses of beta-blockers or Korinfar. In 9 patients with stage II B hypertension refractory to hydrochlorothiazide, PGE2 infusion was performed, which increased the patients' drug sensitivity and reduced blood pressure. Of 134 patients with hypertension refractory to antihypertensive agents and associated with some clinical and biochemical signs of primary hyperaldosteronism 38 had adrenal adenoma and 34 adrenal idiopathic hyperplasia. All the patients were adequately treated.
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PMID:[Some approaches to the treatment of hypertension, refractory to hypotensive agents]. 663 55


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