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

Adrenocortical carcinoma is a rare disorder that can be revealed by an isolated syndrome of mineralocorticoid excess. In a retrospective study of 137 patients referred to our hypertension clinic in the past 10 years for primary aldosteronism, four cases of adrenocortical carcinoma were identified. The clinical presentation of these patients was similar to that of patients with Conn's adenoma, but preoperatively, malignant tumoral primary aldosteronism was suspected because of profound hypokalemia, marked elevation in plasma aldosterone levels, and enlarged size and weight of an heterogenous adrenal tumor with internal calcifications. Malignancy was confirmed by the histologic features. No prognostic criteria could be established and two patients died despite specific surgery, which was performed in all cases. More recent developments in the use of mitotane led to the addition of adrenocorticolytic therapy in the remaining two patients, who are still alive at the time of this report.
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PMID:Isolated clinical syndrome of primary aldosteronism in four patients with adrenocortical carcinoma. 367 52

Operation for tumors responsible for a Conn's syndrome was performed in 16 patients, 11 women and 5 men, over a period of 13 years, the average time before diagnosis being 5 1/2 years. All patients presented hypertension, permanent in 14 and paroxysmal in 2 cases while blood potassium levels were below 3 mmol/l in all patients. Diagnosis was confirmed by elevation of plasma aldosterone and of urine tetrahydroaldosterone, associated with low plasma renin activity not responding to a stimulus. The tumor was demonstrated by imaging in 15 cases before operation and its mean size was 1.7 cm. Investigatory methods for diagnosis and localization are discussed. One patient died during the immediate post-operative period from decompensated cardiac failure. Long-term review showed persistent hypertension in 5 patients but electrolyte disturbances were corrected in all cases. Lack of consistency of results of surgical reduction in case of hyperplasia suggests that only patients with hyperaldosteronism related to an adrenal cortex tumor should be operated upon.
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PMID:[Surgery of Conn's syndrome. Apropos of 16 cases]. 370 May

A case is reported of a primigravid woman presenting in midgestation with severe hypertension caused by primary hyperaldosteronism. Symptomatic treatment with an aldosterone blocker, a peripheral vasodilator, and a combined alpha beta-blocker allowed pregnancy to continue to 36 weeks' gestation. Cesarean section for fetal distress resulted in delivery of a dysmature female infant who did well. Further postpartum studies confirmed the presumptive diagnosis made during pregnancy. An adenoma, localized in the right adrenal gland, was surgically removed.
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PMID:Primary hyperaldosteronism in pregnancy. 377 74

Data describing the 5,485 participants in the stepped-care group of the Hypertension Detection and Follow-up Program were reviewed to determine the apparent prevalence of renal parenchymal and reversible, secondary hypertension. The investigation was limited and was not designed to identify all cases of secondary hypertension. Baseline prevalence of proteinuria was 3.6%, pyuria 7.1%, hematuria 5.1%, and elevated serum creatinine level (greater than or equal to 1.7 mg/dL) 2.7%. The combined occurrence of an elevated serum creatinine level plus one or more urinary abnormalities was noted in 0.95%. Initial review of case reports revealed six participants with hypertension secondary to use of birth control pills and three participants with hypertension that was proved to be secondary to renovascular disease. Specific laboratory or historical criteria were used as indications for more intensive investigation in an additional 65 participants. Among these individuals, one participant with renovascular disease and three with possible primary hyperaldosteronism were identified. A rapid-sequence intravenous urogram or radionuclide scan was performed on another subgroup of 62 participants whose hypertension was "poorly" controlled (diastolic BP, greater than or equal to 95 mm Hg). Fifty-nine studies were negative, one was positive, and two were equivocal. These results suggest that the frequency of clinically relevant cases of reversible, secondary hypertension, at least among individuals with mild to moderate elevation of blood pressure, is low.
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PMID:Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. 387 6

A 68-year-old man a nine-year history of licorice ingestion had moderate hypertension and low plasma potassium. Exchangeable sodium and blood volume were increased to 128 and 111%, respectively of the expected values; plasma renin and aldosterone levels were suppressed. Plasma norepinephrine concentration was distinctly elevated but the pressor response to infused norepinephrine was normal. After licorice withdrawal, blood pressure, plasma potassium and blood volume reverted to normal levels within three weeks, exchangeable sodium and plasma renin within four months. Exchangeable sodium in our patient with licorice-induced hypertension was increased to a comparable extent as in primary hyperaldosteronism. Moreover, blood pressure in relation to body sodium or plasma potassium did not differ between the exogenous or the endogenous types of mineralocorticoid excess. This observation does not support the possibility that in primary hyperaldosteronism excess aldosterone secretion per se could play an important pressor role independently from sodium retention.
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PMID:Body-sodium and blood volume in a patient with licorice-induced hypertension. 388 47

Multiple intracranial aneurysms have been reported in association with polycystic disease of the kidney, brain tumor, pituitary adenoma and coarctation of the aorta. We report the association of multiple aneurysms with primary hyperaldosteronism due to bilateral adrenal hyperplasia in an 18 year old left-handed man who presented with subarachnoid hemorrhage and arterial hypertension. We report the excellent outcome of this patient in spite of a difficult and surgical management. Ligation of all three intracranial aneurysms was performed after an extra-intracranial arterial bypass was done as a protective measure.
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PMID:[Multiple intracranial aneurysms associated with primary hyperaldosteronism]. 398 19

Sodium permeability of erythrocyte membranes was examined, using the recording of maximum rates of sodium-lithium countertransport, in patients with essential hypertension of stages II and III by the WHO classification, renal arterial hypertension, Itsenko-Cushing disease, pheochromocytoma, Conn's syndrome and in subjects with normal arterial pressure who made up a control group. Hypertensive patients demonstrated a more than 60% increase in erythrocyte membrane permeability, as compared to normotensive controls. In patients with pheochromocytoma, the permeability values were almost 40% as low as the control ones. No changes in sodium erythrocyte membrane permeability could be demonstrated in patients with renal hypertension, Itsenko-Cushing disease and Conn's syndrome. It is believed that the erythrocyte membrane permeability parameters can be used for the identification of essential hypertension in the differential diagnosis of hypertensions.
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PMID:[Permeability of the erythrocyte membrane for sodium in hypertension and symptomatic hypertension]. 402 Dec 73

Selective venous blood sampling was performed in 89 patients with hypertension (14 pheochromocytoma, 10 Conn's syndrome, 8 Cushing's disease, 57 essential hypertension). We looked for diagnostic criteria and the valuability of blood sampling from the adrenal veins in such diseases. Defining a norepinephrine concentration of more than 8,000 ng/l as pathological, we had an accuracy of 94.6%. Defining an aldosterone concentration of more than 1,400 pg/ml as pathological, we had an accuracy of 97.4%. In Cushing's disease this method was not very helpful due to overlapping results.
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PMID:Selective blood sampling in adrenal hypertension. 405 28

A father and son are described with a condition characterized by benign hypertension, potassium deficiency, increased aldosterone secretion rate (ASR), raised plasma volume and suppressed plasma renin activity (PRA). There were intermittent elevations of urine 17-ketosteroids and 17-hydroxycorticoids (17-OHCS) but no increase in urine THS, normal circadian rhythm of plasma 17-OHCS, and normal urine 17-OHCS response to dexamethasone and intravenous ACTH. Plasma ACTH and corticosterone secretion were not elevated. Pregnanetriol excretion was normal but urine pregnanediol was increased. At operation on the father no adrenal tumour was found; the excised left adrenal weighed 7 g. and showed nodular cortical hyperplasia; juxtaglomerular cells showed only occasional granules. Following operation hypertension persisted and ASR was half the preoperative value. All abnormalities in father and son were relieved by dexamethasone (DM) 2 mg. daily. The condition recurred following cessation of DM but was relieved by a second course of treatment. No such response to DM was seen in a normal subject or in a patient with Conn's syndrome. For a number of reasons it is suggested that patients with hypertension, increased ASR and low PRA be given a trial of dexamethasone treatment before undergoing adrenal surgery.
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PMID:Hypertension, increased aldosterone secretion and low plasma renin activity relieved by dexamethasone. 428 76

A specific radioimmunoassay for angiotensin II has shown that its normal concentration in arterial blood is 2.4+/-1.2 (S.D.) mmug./l00 ml.; the venous level is consistently below this value, being usually 50-75% of it. Definite rises in blood angiotensin II levels were found in some patients with hypertension, both essential and secondary to renal disease. Extremely low levels were observed in two anephric women, and in one patient with Conn's syndrome. This radioimmunoassay offers a valuable alternative to renin bioassay in evaluation of the role of the renal pressor system in clinical disorders associated with hypertension and aldosteronism.
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PMID:Blood angiotensin II levels of normal and hypertensive subjects. 430 29


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