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)

Thyroid vascular casts were made by injecting a resin, Mercox, into 3 types of hypertensive rats (spontaneously hypertensive rats, SHR, stroke-prone SHR, SHRSP, malignant SHRSP, M-SHRSP), and the vascular casts were observed by scanning electron microscopy (SEM). There was no difference in the general morphology of the vascular casts between SHR and the control (Wistar Kyoto rats, WKY). However, the density and the diameter of blood vessels in SHRSP and M-SHRSP were significantly different from those in WKY, and abnormal vasculatures that formed protrusions with free endings were observed in M-SHRSP. It was concluded that thyroid vascular networks in hypertensive rats were transformed into abnormal formations with decreased capillary diameter in parallel with the progress of hypertension.
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PMID:Morphology of thyroid vascular casts of hypertensive rats. 1731 74

Objective To describe new data about the wide phenotypic variability of diseases due to mutations in the lamin A/C gene (LMNA). Design We report a complex phenotype in a patient with familial partial lipodystrophy of the Dunnigan type (FPLD) and study the frequency of her unusual clinical signs in 19 other LMNA-mutated lipodystrophic patients from 8 different families and 14 non-mutated family members. Case Report The patient was diagnosed with FPLD due to the R482W LMNA mutation after familial screening. Surprisingly, she had no biological signs of insulin resistance. The presence of hypertension with hypokalaemia led to the diagnosis of primary hyperaldosteronism. Thyroid investigations showed a euthyroid multinodular goiter. In addition, the patient exhibited a juvenile akineto-hypertonic syndrome. Results Goiter was identified with a similar frequency (55%) in LMNA-mutated lipodystrophic patients (11 out of 20, originating from 5 families among 8) compared to non-mutated family controls (35%; 5 patients out of 14, all originating from the same family). No case of primary hyperaldosteronism or extrapyramidal syndrome was identified in other studied subjects, either LMNA-mutated or not. Conclusions This R482W-LMNA mutated patient showed an association of features (primary hyperaldosteronism, euthyroid goiter and extra-pyramidal syndrome, raising the question of a link with her laminopathy. Prevalence of goiter tended to be higher in LMNA-mutated than in non-mutated subjects. Hyperaldosteronism seems coincidental. Although extrapyramidal syndrome has never been reported in lipodystrophic patients, it may nevertheless be linked to the LMNA mutation since multiple neurological features have been associated with alterations in lamins A/C.
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PMID:Familial partial lipodystrophy due to the LMNA R482W mutation with multinodular goitre, extrapyramidal syndrome and primary hyperaldosteronism. 1752 34

Hypothyroidism is often associated with adverse cardiovascular risk factors such as high cholesterol together with hypertension, endothelial dysfunction, and other atherosclerotic cardiovascular risk factors. The changed hemodynamic characteristics result in reduced cardiac index, and the renal perfusion is impaired with hyponatremia, and low renin and aldosterone production. The ischemic abnormalities are probably related to long-term consequences of a slow development of hypothyroidism, while the hemodynamic changes can develop in very short-term hypothyroidism. Replacement of hypothyroidism with levothyroxine is associated with a normalization of basal metabolic rate. Most patients with preexisting angina experience a gradual amelioration of symptoms, but in some cases the initial therapy may precipitate an unrecognized ischemic state, worsen a preexisting angina, or even result in myocardial infarction. It is therefore advisable to start replacement slowly and if needed perform a stress test and/or coronary angiography before. It may also in some cases be necessary to monitor the patients closely in a hospital setting during initiation of levothyroxine. Elderly hypothyroid patients with unstable angina pose a particular challenging problem, especially if coronary vascular surgery is indicated. No increased risk of peri- or postoperative death has been noted in small studies, although more complications have been described. It may be relevant to treat the cardiac vascular occlusion before starting replacement with levothyroxine in some cases, after careful weighting of pros and cons in each individual case.
Thyroid 2007 Jul
PMID:Treatment of hypothyroidism in elderly patients and in patients with cardiac disease. 1769 30

A 87-year-old woman presented with hypertension and motor disturbance in upper and lower extremities due to severe muscle weakness. As she had a history of licorice administration, laboratory data was obtained approximately 3 months after the drug cessation. She showed hypokalemia (2.7 mEq/l), metabolic alkalosis and reduced plasma renin activity (PRA). Despite the mineralocorticoid excess, plasma aldosterone concentration (PAC) and 24-hour urine aldosterone were markedly diminished (32 pg/ml and 1.1 microg/day, respectively). Thyroid function was normal, and plasma ACTH and serum cortisol levels were within normal limits. Serum potassium levels was elevated (3.9 mEq/l) and blood pressure returned to normal by cortisol suppression with dexamethasone, 1.5mg per day. Moreover, administration of spironolactone, 50-75 mg per day, caused additional elevation of serum potassium level (4.7 mEq/l) with clinical improvement. These results revealed that the mineralocorticoid excess, found in the present patient, was responsible to dexamesathone and spironolactone, suggesting 11 beta-HSD2 deficiency. Serum cortisol/cortisone ratio (0.95) was also elevated, as compared with age-matched female control (0.28-0.72). The active component of licorice, glycyrrhetinic acid, has a mineralocorticoid-like side effect. However, in the present patient, diminution in serum potassium level and PAC were still found approximately 1 year after stopping licorice. Recently, elderly patients with 11 beta-HSD2 deficiency are often reported, therefore further investigations in relation to the changes caused by aging are needed to elucidate this abnormality.
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PMID:[A 87-year-old woman with mineralocorticoid excess due to 11 beta-HSD2 deficiency]. 1782 12

Overt hypothyroidism (OH) and subclinical hypothyroidism (SH) are frequently found in the elderly. OH is associated with several functional cardiovascular abnormalities and increased risk of atherosclerosis resulting from hypertension associated to atherogenic lipid profile. Other potential atherogenic factors involved in OH are increased circulating C-reactive protein and homocysteine, increased arterial stiffness, endothelial dysfunction, and altered coagulation parameters. Similar (although mild) cardiovascular abnormalities are present in SH. Since all these abnormalities regress with levothyroxine (L-T4) administration, the cardiovascular benefits of replacement therapy in OH are not questionable, independently from the patient's age or the presence of coexisting cardiovascular disease. On the other hand, in spite of a very large number of studies, no consensus has been reached so far about the actual cardiovascular and/or general health impact of SH, and different recommendations have been recently made about screening and treatment of this condition. Although divergent results have been obtained in several epidemiological studies, recent meta-analyses provide evidence for a slight but significant increase of coronary heart disease (CHD) risk in SH. However, no agreement has been reached in favor or against active screening and/or treatment of mild thyroid failure. Moreover, L-T4 therapy is discouraged in aged subjects, because the increased oxygen consumption consequent to thyroid hormone administration could be dangerous, especially in the presence of coexisting CHD. In keeping with this concept are recent data showing reduced mortality risk in untreated mild hypothyroid subjects aged >85 years, suggesting that some degree of decreased thyroid activity at the tissue level might have favorable effects in the oldest-old. However, the effects of subtle thyroid dysfunction may be different in different age ranges. Since the main studies supporting a role for SH as a risk factor for atherosclerosis, cardiovascular disease, and all-cause mortality have been carried out in populations aged > or =55-60 years, mild thyroid failure could concur to increased cardiovascular risk in middle-aged and "young elderly" subjects, while being devoid of detrimental effects and possibly protective in the oldest-old. Further studies are needed to confirm this hypothesis.
Thyroid 2007 Nov
PMID:Cardiovascular risk in elderly hypothyroid patients. 1804 29

Thyroid hormone has many effects on the heart and cardiovascular system. Thyrotoxicosis is associated with increased cardiovascular morbidity and mortality, primarily due to heart failure and thromboembolism. However, the relationship between thyroid hormone excess and the cardiac complications of angina pectoris and myocardial infarction remains largely speculative. Moreover, few studies have been reported on the effect of thyroid hormone levels within normal range on coronary artery disease (CAD). Therefore we examined the association of thyroid function with coronary artery diseases in euthyroid angina patients. Total 192 subjects (mean age; 60.8 yrs) were enrolled in which coronary angiograms were performed due to chest pain. We measured free thyroxine (FT(4)), thyroid stimulating hormone (TSH), serum lipid levels and high-sensitivity C-reactive protein (hsCRP) levels and analyzed their association with the presence of CAD. Serum FT(4) levels were higher in patients with CAD compared with the patients without CAD (1.31 +/- 0.30 vs 1.20 +/- 0.23, p = 0.006), and high FT(4) level was associated with the presence of multi-vessel disease. Multivariate analysis showed that age (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.07, p = 0.007), hypertension (OR 2.04; 95% CI 1.06-3.90, p = 0.036) and FT(4) (OR 4.23; 95% CI 1.12-15.99, p = 0.033), were the determinants for CAD. The relative risk (RR) for CAD in highest tertile of FT(4) showed increased risk compared with the lowest tertile (RR 1.98; 95% CI 0.98-3.99, p<0.001). Our study showed that FT(4) levels were associated with the presence and the severity of CAD. Also, this study suggests that elevated serum FT(4) levels even within normal range could be a risk factor for CAD. Further studies will be necessary to confirm the relationship of thyroid function and CAD.
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PMID:Higher serum free thyroxine levels are associated with coronary artery disease. 1849 53

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by nonresolving pulmonary thromboemboli that can be treated by surgical pulmonary endarterectomy (PEA). The authors of the present study sought to confirm known and to identify novel CTEPH risk factors in a controlled retrospective cohort study of prevalent CTEPH cases collected in three European centres offering PEA. Data from CTEPH patients were compared with nonthromboembolic pre-capillary pulmonary arterial hypertension cohorts at the participating institutions. The study population comprised 687 patients assessed at the time of diagnosis between 1996 and 2007. Ventriculo-atrial shunts and infected pacemakers (odds ratio (OR) 76.40, 95% confidence interval (CI) 7.67-10,351), splenectomy (OR 17.87, 95% CI 1.56-2,438), previous venous thromboembolism (VTE; OR 4.52, 95% CI 2.35-9.12), recurrent VTE (OR 14.49, 95% CI 5.40-43.08), blood groups other than 0 (2.09, 95% CI 1.12-3.94), and lupus anticoagulant/antiphospholipid antibodies (OR 4.20, 95% CI 1.56-12.21) were more often associated with CTEPH. Thyroid replacement therapy (OR 6.10, 95% CI 2.73-15.05) and a history of malignancy (OR 3.76, 95% CI 1.47-10.43) emerged as novel CTEPH risk factors. In conclusion, the European database study confirmed previous knowledge of chronic thromboembolic pulmonary hypertension risk factors, and identified thyroid replacement therapy and a history of malignancy as new medical conditions associated with chronic thromboembolic pulmonary hypertension.
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PMID:Risk factors for chronic thromboembolic pulmonary hypertension. 1918 11

Sunitinib is a novel, oral, multi-targeted tyrosine kinase inhibitor with antiproliferative effects against cancer cells and antiangiogenic properties. Sunitinib was recently approved for the first-line treatment of patients with advanced renal cell carcinoma (RCC) and for the treatment of patients with gastrointestinal stromal tumours (GIST) after disease progression or intolerance to imatinib therapy. The main purpose of this benefit-risk assessment is to review data on sunitinib efficacy along with its toxicity in patients with GIST and RCC. Sunitinib demonstrates a high level of efficacy with acceptable tolerability using either the 50 mg daily oral dosing for 4 weeks every 6 weeks or a continuous daily administration schedule at a lower dose. Hypertension and asthenia appear to be the most common adverse effects with sunitinib. Diarrhoea, anorexia, disgeusia, stomatitis and skin toxicity are other clinically relevant toxicities. Fatigue may, at least in part, be related to the development of hypothyroidism during sunitinib therapy. Skin toxicity consists of bullous lesion in the soles and palms that may require treatment discontinuation for a few days and/or dose reduction. Thyroid hormone levels should be monitored during treatment with sunitinib, with the occurrence of clinical signs of hypothyroidism needing treatment with levothyroxine sodium. Hypertension usually requires standard antihypertensive therapy and treatment discontinuation is less frequently necessary. Mild neutropenia and thrombocytopenia usually require no intervention. A decrease in left ventricular ejection fraction is a rare but potentially life-threatening complication. Although usually well tolerated, sunitinib needs to be administered cautiously with medical follow-up in patients with cancer to prevent, avoid and treat adverse effects in order to improve patient compliance. Its established antitumor activity requires attempting to maintain the highest tolerable dose in individual patients. Current oral formulations allow physicians to modulate dosages (between 25 and 50 mg/day) and/or schedules (4 weeks on, 2 weeks off or continuous administration) to optimize the benefit-risk profile of sunitinib in individual patients.
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PMID:Benefit-risk assessment of sunitinib in gastrointestinal stromal tumours and renal cancer. 1967 Sep 13

Thyroid hormones have several well-recognized effects on the vasculature and heart, resulting in characteristic cardiovascular changes in thyroid disease, including an increase in blood pressure. In hyperthyroidism reduced systemic vascular resistance and increased blood volume lead to an enhanced preload, which, in association with reduced afterload, improved contractility, as well as increased beta-adrenergic activity, results in isolated systolic hypertension based on enhanced stroke volume and cardiac output. In contrast, hypothyroidism causes increased systemic vascular resistance in association with decreased arterial compliance resulting in elevated diastolic blood pressure. Therefore in the evaluation of arterial hypertension secondary hypertension based on thyroid disease should always be considered, especially given the fact that blood pressure changes in the course of thyroid dysfunction are usually reversible upon adequate treatment of hypo- or hyperthyroidism.
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PMID:[Thyroid diseases and hypertension]. 2035 70

Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.
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PMID:Thyroid function and human reproductive health. 2057 83


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