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

A 7-year-old girl presented with the physical and endocrinological stigmata of Cushing's disease. An adrenocorticotropic hormone (ACTH)-producing pituitary microadenoma was excised. Three weeks after trans-sphenoidal adenomectomy, the patient developed benign intracranial hypertension. Although ACTH levels had decreased to normal, the serum cortisol had fallen to subnormal levels. The child responded to exogenous steroid therapy, which was gradually tapered and discontinued after 5 months. Normal pituitary and adrenal functions persist 2 years later.
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PMID:Cushing's disease in childhood: benign intracranial hypertension after trans-sphenoidal adenomectomy. Case report. 631 Apr 37

Clinical and biochemical findings in 13 patients (11 women and 2 men) with macronodular adrenocortical hyperplasia (MNH; nodule size, greater than 0.5 to 5.3 cm) were compared with those of 18 patients (15 women and 3 men) with Cushing's disease and diffuse (n = 9) or micronodular (n = 9) hyperplasia (DH). All were bilaterally adrenalectomized for their hypercorticism. The clinical picture was almost identical in both groups, except for greater frequency of hypertension (13 of 13 vs. 10 of 18; P less than 0.05), alopecia (4 of 11 vs. 0 of 15; P less than 0.05), and scintigraphic lateralization (6 of 7 vs. 1 of 7; P less than 0.05) in the MNH group than in the DH group. The sella turcica was enlarged in 30% of the patients in both groups. Patients with MNH were significantly older than DH patients [43.5 +/- 7.8 (mean +/- SD) vs. 31.7 +/- 10.1 yr; P less than 0.005] and had a 3-fold longer duration of disease (7.8 +/- 4.6 vs. 2.0 +/- 1.1 yr; P less than 0.001) than those with DH. The mean plasma ACTH and cortisol levels and urinary 17-hydroxycorticosteroid excretion were elevated in both MNH and DH patients and responded similarly to specific (corticotropin-releasing hormone and metyrapone) and nonspecific (TRH and LHRH) stimuli. However, dexamethasone suppressibility and the stimulatory effect of ACTH on adrenocortical function were less in the MNH than in the DH group or its subgroups, suggesting a greater degree of adrenal autonomy in the former. Adrenal weight in MNH (15.8 +/- 12.1 g each) was almost twice as high as in DH (8.2 +/- 2.0 g) patients and positively correlated with the duration of the disease. The data suggest that MNH may be a result of long-standing Cushing's disease with varying degrees of pituitary dependence and adrenocortical autonomy, which may lead to confusing biochemical and radiological findings. Bilateral adrenalectomy, rather than hypophysectomy, is the treatment of choice in MNH.
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PMID:Macronodular adrenocortical hyperplasia in long-standing Cushing's disease. 631 61

Male and female, young (2 months old) and mature (10 months old), obese and nonobese, spontaneously hypertensive rats (SHR) were treated with dexamethasone, 5 micrograms/rat and 10 micrograms/rat, respectively, subcutaneously (SC) 2 times daily for 5 months. Steroid treatment stilled the voracious appetite of the obese SHR, and the massively obese, mature animals were reduced to almost normal size. The young, steroid-treated, obese SHR did not develop their genetically programmed corpulency. The untreated, young and mature, obese SHR ate voraciously, became massively obese, and developed their characteristic Cushing's disease-like spectrum of degenerative changes, eg, hypertension, hyperlipidemia, hyperglycemia, muscle wasting, kidney stones, thin skin, and accelerated aging. The blood pressure of the steroid-treated animals was lowered concomitant with reduced levels of circulating ACTH, beta endorphin, insulin, triglycerides, and cholesterol. Dexamethasone caused hyperlipidemia, hyperglycemia, and increased BUN levels in young obese and nonobese SHR only. The mature obese SHR had giant-sized thymus glands that were further enlarged with steroid treatment; dexamethasone was thymolytic in young, obese and nonobese SHR. Dexamethasone caused severe reduction of pituitary and adrenal gland size, simulating the condition of hypophysectomy. These findings demonstrate that dexamethasone suppression of the pituitary-adrenal axis palliates and prevents the spontaneous development of Cushingoid degenerative changes in these genetically obese and hypertensive rats.
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PMID:Dexamethasone suppression of cushingoid degenerative changes in obese spontaneously hypertensive rats (SHR). 631 58

Hypertension is found in association with functioning pituitary tumors causing acromegaly and Cushing's disease. In acromegaly, the cure of the disease or decrease in level of HGH is not seen to correlate with a decrease in blood pressure, perhaps due to longstanding changes such as cardiac enlargement or increased blood volume. Many investigators have reported a cure or improvement of the hypertension in patients with Cushing's disease following successful treatment. Nursing management of the patient with a pituitary tumor should emphasize a thorough history and physical examination as well as an awareness of hypertension and its impact. Nurses must also assume responsibility for careful monitoring both before and after the patient's surgery.
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PMID:Pituitary tumors and hypertension: implications for neurosurgical nurses. 655 11

Over two thirds of patients with Cushing's disease suffer from hypertension. An analysis of 155 patients with Cushing's syndrome was undertaken to study its incidence and effects, and the biological profile and prognosis of the patients. The renin-angiotensin-aldosterone system was given particular attention in 5 patients. Serum angiotensin was raised and a positive correlation was observed with the serum cortisol. Serum aldosterone did not respond as normal to the usual stimuli and the normal plasma renin activity did not vary during the 24 hour period. The physiopathogenesis of hypertension in Cushing's disease is still not fully understood, especially with regard to the mode of action of the hypercortisolism, the essential factor. A mineralocorticoid type of behaviour, especially in the severe forms, may be associated with that of the ACTH-dependent precursors, a permissive action on certain pressor substances, the increase in secretion of angiotensin in parallel to that of the cortisol and finally, the increase in the risk factors probably play a role. The outcome of the hypertension after specific treatment of Cushing's disease is usually favourable. However, hypertension persists in a third of cases.
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PMID:[Hypertension and Cushing's disease]. 662 11

The hypertension of Cushing's disease regresses in about two thirds of cases after specific treatment of this condition. The therapeutic possibilities available at present include the synthetic anticortisol drugs (OP'DDD, aminoglutethimide) adenomectomy and hypophyseal radiotherapy and, finally, bilateral adrenalectomy. The indications of one or the other forms of treatment depend on the presence of a patent hypophyseal tumour, the age of the patient and the stage of the disease. The hypertension requires treatment either because of its severity from the outset or its persistence after treatment of the Cushing's disease. Betablockers or central sympatholytic drugs like clonidine, are then used in monotherapy of first intention. Diuretics should be avoided whenever possible because of the risk of adrenal insufficiency after reduction of the hypercorticism.
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PMID:[Therapeutic strategy in the hypertension of Cushing's disease]. 662 22

Genetically obese and hypertensive rats (Obese/SHR) were subjected to sham or bilateral adrenalectomy at 4-5 weeks of age with the onset of hyperphagia. The sham-operated Obese/SHR ate voraciously and by 180 days of age males weighed 700 g and females 590 g. The adrenalectomized Obese/SHR ate much less and weighed 325 and 225 g. The systolic blood pressure of the intact Obese/SHR ranged from 160 to 170 mmHg, whereas the blood pressure of the adrenalectomized animals ranged from 108 to 110 mmHg. The thymi of the intact Obese/SHR were massive compared to those of the adrenalectomized rats. Adrenalectomy effectively reduced the hyperinsulinaemia, adiposity, hyperlipidaemia, hyperglycaemia, and elevated BUN levels of the obese rats. Several obese rats had old or new myocardial infarcts, fatty livers, giant-sized islets of Langerhans, nodular and hyperaemic adrenal glands, narrow zona glomerulosa devoid of lipid, vacuolated inner cortical zones, foci of intimal fibrinohyalin deposits in mesenteric arteries, early glomerulosclerosis, and large, rounded bladder calculi. The adrenalectomized Obese/SHR displayed none of these stigmata. It is suggested that the genetically programmed obesity and hypertension in these SHR are mediated by abnormal activity of the hypothalamic-pituitary-adrenal-gonadal axis, may be likened to Cushing's disease in the human, and is associated with accelerated ageing.
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PMID:Ameliorative effects of adrenalectomy on the hyperphagia, hyperlipidaemia, hyperglycaemia and hypertension of obese, spontaneously hypertensive rats (Obese/SHR). 701 60

The renin-angiotensin-aldosterone system appears to be under neural and hormonal control. Plasma angiotensinogen concentration is elevated in Cushing's disease, during pregnancy and in women taking oral contraceptives. An in vitro liver slice system was used to study the hormonal control of angiotensinogen synthesis and release in the rat. Dexamethasone administration in vivo resulted in increase in the in vitro rate of release of angiotensinogen by liver slices into the incubation media. This increase was inhibited by actinomycin D, an inhibitor of protein synthesis and vincristine which blocks secretion. Similarly, ethinyl estradiol treatment resulted in a 50% increase in angiotensinogen production. Hyperthyroid state was achieved by injecting rats with L-thyroxine daily for seven days. Hepatic production rate of angiotensinogen rose 21/2-fold above control and was accompanied by increases in plasma angiotensinogen concentration and plasma renin activity. In contrast, plasma angiotensinogen concentration and plasma renin activity were reduced in thyroidectomized rats. The rate of angiotensinogen production by liver slices of these rats decreased by five-fold below that of intact animals. These changes were largely corrected when thyroidectomized rats were treated with replacement doses of L-thyroxine. We conclude that hepatic angiotensinogen biosynthesis is under hormonal control. Glucocorticoid, estrogen and thyroid hormones all stimulate angiotensinogen production. These results may in part explain the pathogenesis of hypertension associated with certain disease states.
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PMID:Hormonal control of angiotensinogen production. 704 Aug 93

Individual features of the endocrine system were studied in 26 healthy men, divided into 2 groups, according to the characteristics of EEG, electrocutaneous thresholds and the time response (TR) upon sound signals of 40 to 120 decibels. The subjects of the 1st group were characterized by the high energy of EEG delta- and theta-rhythms, low energy of alpha-rhythm, low thresholds and TR40 : TR120 ratio. The patients of the 2nd group had the opposite parameters. In both groups the blood plasma and urine catecholamine content, ACTH, TTH, 11-hydroxycorticosteroids, cortisol, aldosterone, thyroxine, triiodothyronine, testosterone and plasmatic insulin were determined by means of spectrofluorometry and radioimmunoassay. The elevation of the cortisol level after ACTH injection and of the TTH concentration following thyroliberin administration were investigated. Two polar variants of the endocrine system organization were revealed. The patients of the 1st group had an elevated activity of the sympathico-adrenal, hypophyseal-adrenal system and insular apparatus, comparatively lowered activity of the hypophyseal-thyroid system and gonads. The subjects of the 2nd group demonstrated an opposite character of the endocrine system. It is suggested that the individual peculiarities of the human endocrine system promote the development of obesity, Icenko-Cushing's disease, hypertension, thyrotoxicosis, acromegaly and bronchial asthma.
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PMID:[Individual characteristics of the organization of the human endocrine system]. 712 44

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


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