Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 50-year old female patient was referred to our clinic. She had systolic-diastolic arterial hypertension, oedemas, physical asthenia, weight loss and a large tumor in the left hypochondrium. Hormone assay showed markedly high values of 17 OHCS, 17 KS and testosterone, and high values of estrogens. The tumor was diagnosed as functional adrenal carcinoma. Removal of the tumor and administration of OP'DDD led to the disappearance of all clinical symptoms and normalization of hormonal values.
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PMID:Feminizing adrenal carcinoma. 408 6

Adrenocortical tumors can be divided into two groups based on their histopathological characteristics, i.e., benign (adenoma) and malignant (carcinoma), and also classified as functioning (or hormonal) and non-functioning (or non-hormonal) tumors, depending on the presence or absence of recognizable clinical syndromes due to excessive steroids. The syndrome of functioning adrenocortical tumors includes Cushing's syndrome, primary aldosteronism and the adrenorge genital syndrome, of which a minority presents most of the specific clinical features: Cushing's syndrome; red face, typical moon face, truncal obesity, and purplisch red striae, primary aldosteronism; muscle weakness, noctural polyuria, hypertension and hypokalemia, adrenogenital syndrome; virilization or feminization, but many of them present complete clinical picture. The diagnosis of these syndromes needs to measure urinary 17-OHCS and 17-KS and plasma concentrations of cortisol, aldosterone, dehydroepiandrosterone (DHEA) and the other steroids. Dexamenthasone suppression test, various stimulation tests and the measurement of plasma ACTH are also useful for diagnosis. Usually, adrenocortical tumors can be detected preoperatively by physical examination or radiographic studies. Some are massive enough to be palpable through the abdominal wall. Some are large enough to cause displacement of the kidney, as seen intravenous urography. Most are visible by adrenal scintigraphy using 131I-iodocholesterol, computerized tomography, or adrenal arteriography. The standard treatment for adrenocortical tumors are surgical resection. Unresectable adrenocortical carcinomas may be treated with an adrenocorticolytic drug, o'p'-DDD. Metyrapone and aminoglutethimide can be also employed to inhibit the production of steroids.
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PMID:[Diagnosis and treatment of adrenocortical tumors]. 631

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

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

Nine cases of malignant adrenal cortical tumour treated during the last decade are reported. As in many other series, these rare tumours were predominant on the left side (7/9) and affected mainly adult females (6/!) with a mean age of 44 years. The 8 secretory tumours were revealed by their hormonal effects: endocrine syndrome or arterial hypertension. The single, clinically non-secretory tumour presented as a palpable mass. The most common findings of hormonal exploration undertaken in 8 of the 9 patients were abolition of the cortisol nycthemeral cycle and non-response to dynamic tests. In 8 cases the tumour was demonstrated by intravenous urography, but its location and extension were best shown by CT scans. Two scintigraphies performed with labelled iodocholesterol were positive. All patients underwent complete excision of the tumour: 5 out of 9 had hepatic metastases at the time of surgery. The median survival of the 7 patients who died was 13 months; 6 of these had received Op'DDD (mitotane) post-operatively. Two patients, including one treated with Op'DDD, are still alive after 18 and 32 months respectively, without signs of recurrence.
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PMID:[Malignant adrenal cortical tumors. 9 cases]. 717 16

The aim of the study was to analyse the changes in pharmacotherapy of ischaemic heart disease (HD) and arterial hypertension (AH) between 1984 and 1988 using the results of screenings of two independent samples of Warsaw inhabitants. In this period the prevalence of IHD in Warsaw population aged 35-64 increased by 4.3% (from 30.3% to 31.6%) as well as the percentage of treated subjects by 19.5% (from 39.0% to 46.6%). Prevalence of arterial hypertension (AH) decreased in this period by 4.7% (from 35.8% to 34.1%) whereas the percentage of undertaking pharmacotherapy in these patients increased by 47.9% (from 33.8% to 50.0%) as well as the effectiveness of undertaken treatment (goal of treatment: < or = 160/95 mmHg) increased by 115.8% (from 22.8% to 49.2%). In subjects with IHD selected from general population the consumption of nitrates, beta blockers and calcium channel blockers increased and these drugs were the most frequently taken in IHD. In treatment of AH diuretics, the most frequently used in 1984, were replaced, to some extent, in 1988 by beta blockers and calcium channel blockers. Consumption of drugs by general population, expressed in DDD/1000 i/day, changed too--the consumption of beta blockers increased in 1988 twice, of calcium channel blockers 3-fold and of nitrates 1.5 fold, whereas that of dipyridamole decreased by 60%, while comparing of these consumption in 1984.
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PMID:[Direction of pharmacotherapeutic changes used in cardiovascular diseases assessed by examination of two population samples from Warsaw]. 771 52

A 39-year-old male presented with gross hematuria and left lower abdominal discomfort. Excretory urography showed a left ureteral stone and hydronephrosis. CT scans and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. Angiography revealed a hypervascular lesion at this area. The laboratory data showed a slightly decreased serum potassium level. In the endocrinological study, the serum deoxycorticosterone (DOC) level was markedly elevated. There was, however, no evidence of hypertension. The operation was performed on November 13, 1992. The tumor was almost separated from the left kidney, but an aberrant artery which divided from the renal artery and penetrated the renal parenchyma was found. Therefore, we had to carry out en bloc removal of the tumor together with the left kidney and the ureter which contained the ureteral stone. Pathological diagnosis was adrenocortical carcinoma. After the operation, hypokalemia and the serum concentration of DOC returned to normal range. Therefore, the tumor was diagnosed as DOC producing adrenocortical carcinoma. The patient was discharged 30 days after the operation with uneventful postoperative course. He received 2.5 g of op'-DDD a day. There was no evidence of distant metastasis or local recurrence 12 months after the operation. Nineteen cases of DOC producing adrenocortical tumor have been reported in the world literature. A case and a review of the literature are herein reported.
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PMID:[Deoxycorticosterone-producing adrenocortical carcinoma--a case report]. 777 67

Mounting evidence shows that elevated resting sinus rate is an independent predictor of cardiovascular morbidity and mortality in the general population, in elderly subjects, and in patients with myocardial infarction or hypertension. Therefore, a rather slow sinus rate appears to be a protecting factor acting through several mechanisms. The present contribution focuses on the relationship between sinus rate and heart failure. Its major objectives are to discuss whether in patients with heart failure a rather slow heart rate is advisable and whether a sinus bradycardia secondary to sinus node dysfunction can facilitate the development of heart failure. It has been reported that among patients with left ventricular dysfunction, increased sinus rate was a predictor of cardiovascular death at univariate analysis; however, a multivariate analysis to verify whether sinus rate was an independent predictor of mortality was not performed. Randomized trials carried out by utilizing beta-blockers or amiodarone in patients with heart failure showed that heart rate reduction by these drugs was a marker of their ability to reduce mortality. However, beta-blockers and amiodarone have additional pharmacological effects which interfere with the disease substrate. So, at present, though the results of these trials show that a rather slow sinus rate is advisable, we do not know whether in patients with heart failure sinus rate represents an independent predictor of mortality as in patients with myocardial infarction or hypertension and whether the reduction of sinus rate per se is beneficial. The results of the recent randomized THEOPACE trial showed, for the first time, that in a patient population with symptomatic sinus bradycardia (sinus rate < 50 b/min), an increase in heart rate, induced by DDD pacing or oral theophylline, reduced the incidence of overt heart failure. Therefore, sinus bradycardia seems to play a role in the genesis of heart failure. In a post-hoc analysis of the results of this trial it emerged that in the control (not treated) group, the subjects with sinus bradycardia more prone to develop heart failure were those of old age, about 80 years, with organic heart disease and severe chronotropic incompetence. However, this conclusion needs further validation.
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PMID:Development of heart failure in bradycardic sick sinus syndrome. 1121 7

A 74-year-old patient was referred for a rapidly increasing pacing threshold 9 months after DDD pacemaker implantation because of symptomatic total atrioventricular (AV) block. She had a history of hypertension, diabetes with micro-angiopathy and a recent transient ischaemic attack. The paced electrocardiogram on admission had a right bundle branch block pattern and 3-dimensional transoesophageal echocardiography demonstrated passage of the lead through an atrial septal defect with a left ventricular position in addition to moderate atherosclerosis of the ascending aorta. No thrombus could be detected on the lead. Percutaneous extraction is usually not recommended because of the risk of mobilization of thrombus material. However, the risk of stroke during removal using cardiopulmonary bypass in this patient was considerably increased because of the presence of multiple independent risk factors. Therefore, percutaneous extraction using a locking device was selected and performed without complications: follow-up was uneventful.
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PMID:Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead. 1263 46

A 50-year-old man with a heart murmur from early childhood and a one year history of general fatigue was admitted. Cardiac examination showed a left ventricular-right atrial (LV-RA) communication, and aortic and mitral valve regurgitation (III/IV). At surgery, the LV-RA communication was located in the atrioventricular membranous portion 3 mm above the septal leaflet of the tricuspid valve. The etiology of the LV-RA communication was congenital and valvular diseases were acquired changes caused by sclerosis due to infected endocarditis or hypertension. The diameter of the LV-RA communication defect was 6 mm, and the fibrous tissue around the defect was closed directly. Next, double-valve replacement was performed safely. However, the day after surgery, the patient developed complete atrioventricular block and implantation of a DDD pacemaker was required. He was discharged without other complication. We recommend the careful closure of the LV-RA communication defect, if the defect is small and rich in fibrous tissue.
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PMID:[Surgical treatment of left ventricular-right atrial communication complicated with aortic and mitral valves regurgitation: report of a case]. 1497 6


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