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

The circadian rhythm of blood pressure in 11 patients with primary aldosteronism (ALD) and 15 patients with unilateral renovascular hypertension (RVH) was analyzed using the cosinor method which fits a cosine function to a series of data. In ALD, both systolic (SP) and diastolic blood pressures (DP) increased in the late evening; the amplitude and acrophase of the circadian rhythm for SP were 7.3 (5.3 to 9.3, mean and 95% confidence limits) mmHg and 20:47 (19:42 to 21:52) hours, respectively, and for DP 2.6 (1.3 to 3.9) mmHg and 21:34 (19:40 to 23:28) hours, respectively. After excision of an adrenal adenoma in 6 patients, the circadian rhythm of SP and DP was abolished. In RVH, the acrophase of the circadian rhythm of SP and DP differed by about 12 hours; the amplitude and acrophase for SP were 5.7 (3.9 to 7.5) mmHg and 17:49 (16:35 to 19:02) hours, respectively, and for DP 1.5 (0.2 to 2.7) mmHg and 6:08 (2:44 to 9:31) hours, respectively. After various surgical interventions in 8 patients, the circadian rhythm of SP persisted with little change in acrophase, while that of DP disappeared. The difference in circadian rhythm suggests a difference in mechanisms of blood pressure control in ALD and RVH.
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PMID:Circadian rhythm of blood pressure in primary aldosteronism and renovascular hypertension--analysis by the cosinor method. 686 83

The value of the urine tests: free aldosterone, aldosterone-18-glucuronide, tetrahydroaldosterone 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone in distinguishing primary aldosteronism from essential hypertension was studied in patients with typical and atypical primary aldosteronism and in patients with essential hypertension. The discriminating function of the tetrahydroaldosterone determination was the best, followed by 18-hydroxycorticosterone, free aldosterone and aldosterone-18-glucuronide. The measurement of 18-hydroxydeoxycorticosterone was without distinguishing value. Three cases with hypertension, adrenal adenoma, elevated 18-hydroxycorticosterone but normal aldosterone values were observed. In longitudinal studies the excretions of aldosterone, aldosterone metabolites and possible precursors periodically varied independently of each other. Determinations of urine aldosterone, aldosterone metabolites, 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone were not applicable for differential diagnosis of the adenoma and hyperplasia forms of primary aldosteronism.
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PMID:Aldosterone metabolites and possible aldosterone precursors in hypertension. 688 70

Midsystolic cessation of left ventricular contraction was documented in a patient with hypertrophic nonobstructive cardiomyopathy (HCM) associated with Cushing's syndrome (adrenal adenoma) without history of hypertension. The carotid pulse tracing showed a rapid upstroke with a prominent percussion wave which was rapidly decayed at midsystole followed by a tiny tidal wave. The decay of this percussion wave coincided in timing with midsystolic closure of the aortic valve in the echocardiogram. The left ventricle (LV) was symmetrically hypertrophied (wall thickness = 1.8 cm). The motion of the interventricular septum and LV posterior wall appeared trapezoid, and the contraction of these walls was normal in early-systole followed by the sudden cessation at midsystole till end-systole. Systolic anterior motion of the mitral valve was not observed. Cardiac catheterization revealed no pressure gradient in the LV even after the various provocative maneuvers. The left ventriculogram simultaneously recorded with LV pressure showed that LV ejection was completed at midsystole, when LV pressure fell from 98 to 83 mmHg. Mitral regurgitation was not observed. Midsystolic cessation of left ventricular contraction in this case is thought to be the cause of sudden interruption of forward aortic flow, resulting in a bifid carotid pulse and midsystolic closure of the aortic valve in the echocardiogram.
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PMID:[Midsystolic closure of the aortic valve in hypertrophic nonobstructive cardiomyopathy]. 689 Sep 68

The diagnostic results in 32 patients (23 female, 9 male) with Cushing's syndrome are presented. 20 patients had pituitary Cushing's syndrome (mean age 36.2 +/- 15.9 years), 7 unilateral adrenal adenoma (mean age 37.1 +/- 15.3 years) and 4 (mean age 54.8 +/- 10.8 years) carcinoma of one adrenal gland. One patient had an ectopic ACTH syndrome based on a Zollinger-Ellison syndrome. Hypertension was observed in 84% of the 32 patients. The basal urinary excretion rates were pathologically high in 99% of all measurements, while the excretion rates for 17-OH-steroids were pathologically elevated only in 61% of all measurements. Radioscanning of the adrenal glands was performed in 11 patients with 131I-cholesterol derivatives of NP-59. 4 patients with pituitary Cushing's syndrome had bilaterally increased uptake of activity, while 3 patients with adenoma had uptake of the radiolabeled drug on the side of the lesion. In all 4 patients with a carcinoma, uptake was absent or insufficient. The results show that measurement of the basal urinary excretion rate of free cortisol is a more sensitive means for detection of hypercorticism than measurement of 17-hydroxysteroids. Radioscanning of the adrenal glands provides reliable results in pituitary Cushing's syndrome and adenomas, but, in our cases, not in carcinomas.
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PMID:[Special diagnosis in Cushing's syndrome]. 694 89

We were able to observe the effect of withdrawal of endogenous sympathetic drive in a hypertensive patient with an aldosterone-secreting adrenal adenoma. Acute stimulation of both carotid sinus nerves lowered blood pressure to normotensive or hypotensive levels by reducing peripheral resistance. When chronic carotid sinus nerve stimulation was discontinued, peripheral resistance and blood pressure increased. These data suggest that the sympathetic nervous system is important in the maintenance of hypertension in established primary aldosteronism.
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PMID:Withdrawal of endogenous sympathetic drive lowers blood pressure in primary aldosteronism. 697 70

The renin-angiotensin-aldosterone system (RAAS) in a female patient suffering from acromegaly and severe hypertension was studied and a suppressed plasma renin activity could be found. A catheterisation of both adrenal veins, a bilateral adrenal gammagraphy and an abdominal CT scan confirmed the diagnosis of an aldosterone-producing right adrenal adenoma (Conn's Syndrome). We greatly emphasized the need of investigating the RAAS in acromegalic patients suffering from hypertension.
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PMID:Conn's syndrome in a patient with acromegaly. 701 5

Amiloride is a potassium-sparing diuretic used in spontaneous and diuretic-induced hypokalemia. The effect of amiloride was studied prospectively in 12 patients with primary hyperaldosteronism. Four patients had unilateral adrenal adenomas and eight had bilateral adrenal hyperplasia. All patients were hypertensive and their mean plasma potassium levels were low. Amiloride, 10 to 40 mg daily, was given for 6 mo. Mean plasma potassium levels rose (0.96 mEq/l, P less than 0.001) and remained normal throughout the study without potassium supplementation. Mean blood pressure was lowered by amiloride (22/10 mm Hg, P less than 0.001) but normotension required concomitant antihypertensive therapy in most patients. No significant adverse clinical or laboratory experiences could be directly attributed to amiloride therapy. There was no correlation between the response to therapy and the plasma aldosterone levels, aldosterone secretion rate, or presence of a unilateral adrenal adenoma. Our study demonstrates the efficacy of amiloride in the correction of hypokalemia and amelioration of hypertension in primary hyperaldosteronism.
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PMID:Amiloride in primary hyperaldosteronism. 705 5

The present study involved 143 patients with confirmed Cushing's syndrome, including 100 with Cushing's disease, 20 with adrenal adenoma and 23 with adrenal carcinoma. Out of 120 assessable patients 68% had arterial hypertension and the majority of these (78%) presented with adrenal carcinoma. Blood pressure returned to normal in 85% of hypertensive cases after Op'DDD therapy or adrenalectomy. Excessive cortisol production is probably the main cause of hypertension, but the precise pathophysiological mechanism is controverted. Serum lipids were studied in 88 patients, 40% of whom were found to have combined hyperlipoproteinaemia, this abnormality being particularly frequent in patients with malignant adrenal tumour. Serum cholesterol levels returned to normal after adrenalectomy. However, they were further increases during Op'DDD treatment (p less than 0.01) and only became normal after withdrawal of the drug. Cerebral vascular accidents were uncommon (6%) and might have been due to cobalt irradiation of the hypothalamus-pituitary region.
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PMID:[Cardiovascular diseases and lipid abnormalities in Cushing's syndrome]. 714 56

Described here is a 27-year-old female, who had centripetal obesity, broad reddish-purple striae on the lower abdomen and hypertension. Serum cortisol levels, the results of a dexamethasone suppression test and an adrenal scintigram with 131I-19-iodocholesterol were all compatible with Cushing's syndrome due to an adrenal adenoma that secretes cortisol autonomously. This was confirmed by gross and microscopic examination of the removed adrenal tumor. In addition, the patient had markedly diminished T4 and T3 concentrations in serum. Basal TSH levels were not elevated and did not rise significantly after TRH injection. Serum T4 and T3 concentrations were elevated to the normal range when the hyperadrenocorticism was corrected. The results indicate that the patient had "'corticogenic hypothyroidism."
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PMID:Cushing's syndrome associated with corticogenic hypothyroidism: a case study. 730 57

In 20 patients with a clinical picture of primary hyperaldosteronism (5 patients were later found to be suffering from hypertension of other origin), CT showed diagnostic precision higher than 90% in the localization of adrenal adenoma (11 out of 12). On the other hand, this examination scarcely helped in the diagnosis of uncommon gland hyperplasias (1 out of 3). In CT doubtful or negative cases, hormonal measurement in blood samples taken selectively from adrenal veins was more indicative than selective phlebography. CT can therefore be considered as an alternative to iodocholesterol scintigraphy in early diagnostic investigation in this field of pathology.
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PMID:[Diagnostic possibilities of computerized tomography in primary hyperaldosteronism (author's transl)]. 733 Feb 98


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