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 49-year-old woman was diagnosed in 1985 as having pheochromocytoma because of hypertension with high levels of plasma catecholamine concentration and 24-hour urine excretion of vanillyl-mandelic acid and metanephrine together with a right adrenal mass. The excised tumor cells had fine granular basophilic cytoplasm with argyrophilic granules by Grimelius' method. Four years later, she was diagnosed as having a duodenal bulb ulcer. Serum gastrin showed an abnormally high level of 1900 pg/ml. Abdominal echogram and computed tomography revealed a hypoechoic lesion in the pancreas and intrahepatic multiple tumors. A needle biopsy specimen of the liver tumor was compatible with the histology of metastatic islet cell tumor. A diagnosis of Zollinger-Ellison syndrome was made due to malignant gastrinoma with multiple liver metastases. The patient had no family history of endocrinological or neoplastic disorders. The present case indicates the possibility that pheochromocytoma and gastrinoma, that is, endocrine tumors characteristic of multiple endocrine neoplasia (MEN) I and MEN II, may be coincident even in a person without MEN. A continued awareness of previously rare or undescribed manifestations is important in patients with islet cell tumors or pheochromocytoma.
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PMID:Zollinger-Ellison syndrome and pheochromocytoma. Report of a case. 809 84

A 31-year-old male was admitted to our hospital for further examination of a right adrenal mass, which was incidentally discovered by abdominal ultra-sonography in another hospital. The adrenaline and noradrenaline in the plasma and the adrenaline and VMA in the urine were slightly elevated, and catecholamines in the blood from the right adrenal vein were markedly increased. Glucose tolerance test showed a borderline case. Otherwise, there was no clinical sign. Asymptomatic pheochromocytoma originating from the right adrenal gland was suspected in the preoperative diagnosis. Laparoscopic right adrenalectomy was performed. Although the blood pressure was stable preoperatively, paroxysmal hypertension was observed during the tumor manipulation. Blood pressure was well controlled during the operation with ATP, nitroglycerin and phentolamine. Blood loss was less than 150ml, and there was no surgical complication. The resected tumor specimen was 32[28[33mm in size, weighed 14g, and histological examination showed typical pheochromocytoma. The post-operative course was unremarkable and glucose tolerance test was normalized after the operation. This is the first case of the successful removal of pheochromocytoma using the laparoscopic procedure.
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PMID:[An incidentally found asymptomatic pheochromocytoma: a case report--successful removal laparoscopic adrenalectomy]. 828 34

A case of stage 4 neuroblastoma that developed excessive hypertension on day 120 of chemotherapy is presented. The tumor initially had responded well to chemotherapy; however, while the tumor mass decreased, plasma and urine catecholamines and the blood pressure increased. The plasma concentrations of noradrenaline, adrenaline, and dopamine increased to 26.4, 1.8, and 36.2 micrograms/l, respectively. The profile of catecholamine metabolites changed: on day 150 of therapy, noradrenaline, adrenaline, and dopamine levels were increased, whereas HVA and VMA levels were decreased when compared to day 1 of therapy. The only residual neuroblastoma tissue visible on MIBG scintigraphy on day 150 of treatment was a metastasis in the left tibia which was irradiated with 24 Gy. The adrenaline concentration in the left femoral vein was twice as high compared to the right femoral vein. A treatment, possibly radiation-associated tumor cell alteration resulting in a different catecholamine production, is discussed.
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PMID:Development of hypertension in neuroblastoma during therapy: a case report. 851 30

A 46-year-old female first presented to our clinic with a chief complaint of an abdominal mass. A computerized tomographic (CT) scan revealed a 6 cm retroperitoneal mass below the left kidney. Preoperative hormonal examinations showed elevation of catecholamines and vanillymandelic acid (VMA) in her 24-hour urine, although she had no hypertension. Therefore, the tumor was uneventfully removed and histologically diagnosed as pheochromocytoma. It is difficult to preoperatively diagnose normotensive extra-adrenal pheochromocytoma without any considerations of the possibilities. However, it may be hazardous to treat pheochromocytoma surgically without any preparations. In the present case, we emphasized the importance of preoperative accurate diagnosis of extra-adrenal pheochromocytoma and discussed briefly the clinical features in the literature.
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PMID:[A case of asymptomatic extra-adrenal pheochromocytoma]. 869 63

Adrenal masses are more and more frequently detected by adrenal ultrasound, computed tomography or nuclear magnetic resonance carried out for a reason other than the suspicion of adrenal disease (incidentalomas). The findings of an incidentaloma still leaves many diagnostic and therapeutic questions open. We report the results of a multicentric retrospective evaluation of patients with adrenal incidentalomas, performed by a Study Group of the Italian Society of Endocrinology. According to the definition of incidentaloma, exclusion criteria a priori were: severe or paroxysmal hypertension, frank hypokalemia and clinical signs of hypercortisolism or hyperandrogenism. 29 centers participated in the study and the data obtained by questionnaire were collected in 2 centers for final elaboration. Center 1 carried out the epidemiological and clinical evaluation. Basal and dynamic hormonal evaluation of 786 among the 1013 cases recruited were performed in our center (center 2). Functional studies included: diurnal rhythm of cortisol, urinary free cortisol (UFC), ACTH, DHEAS, 17-OH progesterone, testosterone, androstenedione, supine and upright plasma renin activity (PRA) and aldosterone, urinary aldosterone, urinary catecholamines and VMA. The hormonal dynamic evaluation included the overnight dexamethasone suppression test (1 mg), CRH test and ACTH test. In our study, 89% (702 patients) of adrenal incidentalomas were non-hypersecretory masses; 6.2% (49 patients) showed a preclinical Cushing's syndrome (PCS) (at least two altered parameters of pituitary-adrenal axis); 3.4% (27 patients) were pheochromocytomas; 0.89% (7 patients) were aldosteronomas. One tumor was a masculinizing adrenocortical carcinoma. Two hundred sixty patients underwent surgical exploration and the histological diagnosis showed: 138 adenomas (53%), 32 carcinomas (12%), 26 pheochromocytomas (10%). 16 myelolipomas (8%), 13 cystic lesions (5.5%), 7 tumors of neuronal lineage (3%). 12 metastases (4%), 13 others (5%). The 138 patients with adenomas had the following hormonal diagnosis: 103 nonfunctional adenomas (74%), 31 PCS (23%) and 4 cases of hyperaldosteronism (3%). In the patients with PCS an abnormal dexamethasone suppression test was found in 86% of cases (37/41 patients). Values for ACTH were low in 78% (32/41 patients). UFC was elevated in 64% of patients, the diurnal rhythm of cortisol evaluated in 14 patients was absent in 7. Only in 50% of cases DHEAS values (12/24 patients) were decreased, whereas they were normal in the other 50%. Interestingly, 8 patients with normal DHEAS and normal UFC showed nonsuppressible cortisol by dexamethasone test (1 mg). Blunted ACTH response to CRH was detected in 9 of 14 patients (64%). Thus our data suggest that the best parameter for evaluating subclinical hypercortisolism seems to be the overnight dexamethasone suppression test. In 27 patients with pheochromocytoma 24-hour urinary catecholamine and VMA levels were elevated in 86 and 46% of cases respectively. In 7 patients with hyperaldosteronism upright PRA was suppressed in 100% of cases and aldosterone plasma levels were elevated in 6 patients (86%); serum potassium level was slightly decreased in 60% of cases. In 86 of 138 histologically proven adenomas, DHEAS levels were: normal in 59% of patients, decreased in 36% and elevated in 4.6%, whereas in 22 of 32 cortical carcinomas evaluated. DHEAS levels were normal in 63% of cases, decreased in 18% and elevated 18%. Post-ACTH 17-OH progesterone levels were elevated in 52% (62/118 patients) of non-functioning adenomas and in 2 of 4 carcinomas. Not enough data are yet available postoperatively. In summary, endocrine evaluation can lead to the identification of a nonnegligible number of cases of clinically unsuspected pheochromocytomas and subtle hypercortisolism (about 3.4 and 6.2%, respectively of all adrenal incidentalomas), while cases of primary subclinical aldosteronism are rarely found. (ABSTRACT TRUNCATED)
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PMID:Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. 916 66

Due to more frequent occurrence of the idiopathic arterial hypertension of borderline type (18.97% of screened women), with values varying from 18.7/12.0 to 21.3/12.7 kPa (140/90-160/95 mm Hg), in women chronically exposed to carbon disulfide as compared to the control group (8.5% women), we decided to investigate the activity of sympathetic-adrenal nad serotoninergic systems that play an important role in the haemostasis of cardiovascular system. The aim of the presented study is to evaluate the linear correlation between: 1) serum dopamine-beta hydroxylase activity and the dopamine concentration in plasma as well as 24-hours adrenaline and noradrenaline excretion in the urine; and 2) between catechol-0-methyltransferase and monoaminoxidase activity and the 24-hours excretion of catecholamine in the urine; next the serum and platelet concentration of serotonin and the arterial blood pressure in women chronically exposed to carbon disulfide. The investigations were performed on 140 women, aged 22 to 55, who were divided into two groups: group-I the control group, covered 50 women employed in the Industrial Clothing Factory "Dana" in Szczecin. Group II-the study group, consisted of women employed in the Synthetic Fibres Factory "Wiskord" in Szczecin-Zydowce, in the carbon disulfide (CS2) atmosphere in concentration from 9.36 to 23.4 mg/m3. The microclimate conditions of the production halls in both groups were similar (Tab. 1). It has been observed that in women chronically exposed to CS2 plasma dopamine concentration (p < 0.001) and DBH serum activity (p < 0.001) are significantly lower as compared to the control group parameters (Tab. 2). Also dopamine concentration and DBH activity are lower in all subgroups of women exposed to CS2 (Tab. 3). In women working in the CS2 atmosphere, 24-hours excretion of adrenaline is significantly lower (p < 0.001) as compared to the control group. Parameters for 24-hours noradrenaline and VMA excretion in the urine do not show any statistical significance (Tab. 4). Plasma (p < 0.001) and platelet (p < 0.001) concentration of serotonin is significantly higher in women exposed to CS2. However, 24-hours 5-HIAA excretion in the urine in women of group II is higher than in group I, but does not give evidence of any statistical significance (Tab. 6). Both serum (p < 0.001) and platelet (p < 0.001) MAO activity is significantly lower in women chronically exposed to CS2. Also COMT erythrocyte activity is significantly lower (p < 0.001) in the studied group women (Tab. 8). The women working in the CS2 evaporation display significantly higher serum concentration of total (p < 0.001), bound (p < 0.001) and free (p < 0.001) tryptophane (Tab. 9). In women exposed to CS2, serum concentration of zinc (p < 0.001) and copper ions (p < 0.001) is significantly lower (Tab. 10). In comparison to the control group parameters, the women exposed to CS2 claim values of systolic and diastolic arterial blood pressure being insignificantly higher. However, in women working in CS2 atmosphere the coefficients of linear correlation between plasma (r = 0.59; p < 0.001) and platelet (r = 0.73; p < 0.001) serotonin concentration and the systolic arterial blood pressure, as well as plasma (r = 0.065; p < 0.001) and platelet (r = 0.72; p < 0.001) serotonin concentration and the diastolic arterial blood pressure are significantly higher (Tab. 11). Significantly positive linear correlation between serotonin concentration and arterial blood pressure in women chronically exposed to CS2 may suggest the important role of this amine in the pathogenesis of arterial hypertension.
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PMID:[The influence of chronic exposure to carbon disulfide on metabolism of catecholamines and serotonin in women]. 919 18

Presentation of 7 case reports of pheochromocytome, diagnosed and treated in our Centre between 1981 and 1995. Clinically all patients had hypertension. Three presented the triple condition of hypertension, pulsatile headache and palpitations. The most useful analytical studies were urine vainillylmandelic acid (VMA) and catecholamines. The main radiologic method was the scanner (CT). Pre-surgical preparation was with alpha-blockers in 5 patients, adding beta-blockers in 3. Treatment was surgical in all cases, and the approach was selected based on the tumour's size and location. One patient with severe rheumatic heart disease died on day 3 post-surgery. Mean follow-up is 19 months, and only one patient requires anti-hypertensive medication following surgery.
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PMID:[Pheochromocytoma]. 941 19

Presented is a case of pheochromocytoma with an ectopic or extrarenal localisation in a 47 year old female farmer. The patient was admitted to the 1st Chair and Clinic of Internal Disease, Jagiellonian University Collegium Medicum due to a three year history of hypertension. The bouts of hypertension were characterised by sudden increases of blood pressure to 250/150 mmHg, which occurred after physical exertion but particularly during the night. On physical examination no abnormalities were detected. Laboratory analysis revealed no changes apart from mild hyperglycemia. 24 hour vanillymandelic acid excretion was normal on two successive accounts, but on a third analysis was raised. Fundus examination revealed bilateral hypertensive and diabetic angiopathy. Abdominal ultrasound revealed a tumor in the region of the pancreas with an echogenicity similar to that of the liver. Abdominal CT scan revealed normal suprarenal glands bilaterally. A smooth walled tumor of 55 mm diameter was visualized below the head of the pancreas. Its structure was not uniform with degenerating features. The tumor adhered to the descending and transverse part of duodenum, compressing the vena cava inferior and was in close proximity to the abdominal aorta. After surgical consultation the patient was transferred to the II Clinic of General Surgery Jagiellonian University Collegium Medicum where after pretreatment with alpha and beta blockers, ACE inhibitors, diuretics and Insulin CHOS the patient underwent surgery. Posterior to the duodenum, inferior to the head of the pancreas, between the aorta and vena cava inferior was a polycystic tumor of 80 mm diameter, which was evacuated in its entirety. Histopathology revealed a paraganglioma with an appearance of pheochromocytoma. On a three month follow up visit the patient was without symptoms. Her blood pressure and glycemia were normal despite being without treatment.
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PMID:[Peri-renal pheochromocytoma]. 985 14

An investigation has been made to elucidate the role of sympathetic nervous system (SNS) in the development of renal hypertension and hyperglycemia in rats and rhesus monkeys using 6-hydroxydopamine (6-OHDA). Development of renal hypertension was blocked in weanling rats (80%), demedullated adult rats with 6-OHDA (75%) but not in adult rats sympathectomised with 6-OHDA. Weanling rats treated with 6-OHDA did not have any detectable catecholamine stores when measured 60 days after treatment with 6-OHDA. Unlike the weanling rats the hearts of the adult rats showed significant refilling of catecholamines 60 days after 6-OHDA treatment. 6-OHDA treatment and adrenalectomy did not modify the development of streptozotocin (STZ) induced hyperglycemia and the hypoglycemic effect of tolbutamide and phenformin. Chemical sympathectomy with 6-OHDA did not show any glucose intolerance in rhesus monkeys or any effect or insulin release. Phentolamine (PHE) and oxprenolol (OXP) pretreatment had no effect on development and maintenance of hyperglycemia. Although there was no effect on the endogenous catecholamines stored in the heart and brain in the diabetic rats, there was a marked increase in the urinary excretion of norepinephrine (NE), epinephrine (E), 3-methoxy-4 hydroxy mandelic acid (VMA) and creatinine. The rate of disappearance of (3H)-NE from rat heart was higher when compared to age matched controls. Diabetic rats showed increase responsiveness to angiotensin II and developed hypertension faster when their renal arteries were clamped as compared to controls. It is concluded that the functional SNS is important in the development of renal hypertension in the rat. Further the SNS in the rats and rhesus monkeys does not play any significant role in the STZ induced hyperglycemia, glucose intolerance and insulin release.
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PMID:Role of sympathetic nervous system in experimental hypertension and diabetes mellitus. 1005 46

A 38 year-old man presented with upper abdominal mass and hypertension pointed out at a medical examination. Blood pressure was 170/90 under medication of an alpha-blocker. Abdominal CT scan showed an 8 x 8 cm inter-aortocaval mass displacing pancreas head ventrally, and further a 4 x 4 cm mass at the aortic bifurcation, but there was no tumorous lesion in bilateral adrenal glands. Plasma nor-epinephrine level and urinary VMA excretion were excessive but plasma adrenaline level was within normal limits. MIBG scintigram showed hot spots in the 4th and 9th thoracic vertebrae. The destructive change of the 9th vertebra on magnetic resonance imaging strongly suggested metastasis of the tumor. Histologic and immunohistochemical findings of the biopsy specimen taken from the lower abdominal tumor in addition to the above clinical data led to the diagnosis of extra-adrenal malignant pheochromocytoma with spinal metastases. Since 2 cycles of full dose CYVADIC chemotherapy had no effects on lowering the high blood pressure and reducing the tumor size, low dose (60% of the full dose) CVD (cyclophosphamide, vincristine and dacarbazine) was given as a palliative chemotherapy on an out-patient clinic approximately every 4 weeks. After 4 cycles of the chemotherapy, his backache due to spinal metastasis markedly improved, hypertension as well as the plasma dopamine level was normalized and nor-epinephrine level was markedly decreased, though the tumor size was not reduced. Thereafter, no medication for hypertension was necessary. During 3 years and 6 months until now, 36 cycles of the chemotherapy has been repeated with no significant side effects. He has been at full-time work with quality of life being well preserved. Low dose CVD regimen appears to be an effective tumor dormancy therapy for advanced extra-adrenal pheochromocytoma.
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PMID:[Low dose CVD chemotherapy as a tumor dormancy therapy for extra-adrenal malignant pheochromocytoma: a case report]. 1151 73


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