Endocrine arterial hypertension - Causes, symptoms and treatment. MF.

Arterial hypertension is a persistent increase in pressure in arteries above 140/90 mm Hg. Most often( 90-95% of all cases) causes of the disease can not be identified, then hypertension is called essential .In a situation where the increased pressure is associated with any pathological condition, it is considered secondary( symptomatic) .Symptomatic hypertension is divided into four main groups: renal, hemodynamic, central and endocrine.

In the structure of morbidity, endocrine arterial hypertension occupies 0.1-0.3%.Given the wide spread of hypertension, almost every doctor repeatedly meets with endocrine arterial hypertension in his practice. Unfortunately, often the pathology remains unrecognized and the patients get ineffective treatment for years, which provokes complications from sight, kidneys, heart, brain vessels. In this article, we will discuss the main points of the symptoms, diagnosis and treatment of hypertension associated with the pathology of endocrine glands.

When is a detailed examination necessary?

Secondary arterial hypertension is rarely diagnosed( about 5% of cases in Russia).However, it can be assumed that in a number of cases secondary, the character of the pressure increase is simply not revealed. At whom from patients it is possible to suspect such situation? Here are the main groups of patients who need a detailed examination:

- those patients who have maximal doses of antihypertensive drugs according to standard schemes do not lead to stable normalization of pressure;
- young patients( under 45 years old) with severe hypertension( 180/100 mm Hg and above);
- patients with hypertension, whose relatives at a young age suffered a stroke.

In some of these patients, hypertension is primary, but it can be verified only after a detailed examination. In the plan for this diagnosis, it is necessary to include a visit to the endocrinologist. This doctor will evaluate the clinical picture and possibly prescribe hormonal tests.

Which endocrine pathology leads to hypertension?

Glands of internal secretion produce special signaling compounds - hormones. These substances are actively involved in maintaining the constancy of the internal environment of the body. One of the direct or indirect functions of a part of the hormones is also the maintenance of adequate blood pressure. First of all, we are talking about hormones of the adrenal glands - glucocorticosteroids( cortisol), mineralocorticoids( aldosterone), catecholamines( adrenaline, noradrenaline).Thyroid hormones of the thyroid gland and growth hormone of the pituitary gland also play a role.

The reason for increasing the pressure in endocrine pathology can be, first, the delay of sodium and water in the body. Secondly, hypertension provokes hormonal activation of the sympathetic nervous system. The high tone of this department of the autonomic nervous system leads to increased heart rate, an increase in the force of contraction of the heart muscle, a narrowing of the diameter of the vessels. So, the pathology of the adrenal gland, thyroid gland, pituitary gland can be the basis of arterial hypertension. Let's take a closer look at each disease.

Acromegaly

Acromegaly is a severe chronic disease that most often causes a pituitary tumor that produces growth hormone. This substance, among other things, affects the exchange of sodium in the body, causing an increase in its concentration in the blood. As a result, excess fluid is retained and the volume of circulating blood increases. Such adverse changes lead to a persistent increase in blood pressure. Patients with acromegaly have a very characteristic appearance. Growth hormone promotes thickening of the skin and soft tissues, superciliary arches, thickening of the fingers, increasing the size of the feet, the lips, nose, and tongue also increase. Changes in appearance occur gradually. They always need to be confirmed by comparing photographs of different years. If a patient with a typical clinical picture is also diagnosed with hypertension, the diagnosis of acromegaly becomes more likely.

For accurate diagnosis it is necessary to determine the concentration of growth hormone in the blood on an empty stomach and after taking 75 grams of glucose. Another important analysis is IGF-1 venous blood. For visualization of a tumor of the pituitary gland, magnetic resonance imaging or computed tomography with the introduction of a contrast agent is best.

When confirming the diagnosis of acromegaly, surgical treatment is most often performed. Basically, transnasal removal of the pituitary tumor takes place. Radiation therapy is performed in the event that surgery is impossible. Treatment with medicines alone( somatostatin analogues) is rarely used. This therapy plays a supporting role in the periods before and after radical interventions.

Thyrotoxicosis

Thyrotoxicosis is a condition caused by an excessive concentration of thyroid hormones in the blood. Most often, thyrotoxicosis provokes a diffuse toxic goiter, toxic adenoma, subacute thyroiditis. Thyroid hormones affect the cardiovascular system. Under their action, the rhythm of the heart sharply increases, the cardiac output increases, the lumen of the vessels narrows. All this leads to the development of persistent arterial hypertension. Such hypertension will always be accompanied by nervousness, irritability, insomnia, weight loss, sweating, "fever" in the body, trembling in the fingers.

To confirm the diagnosis of thyrotoxicosis hormonal studies are prescribed: thyroid-stimulating hormone( TSH), thyroxine( T4 free), triiodothyronine( T3 free).

If the diagnosis is confirmed, then the treatment starts with conservative therapy with thyreostatics. Then an operation or radioisotope treatment can be performed.

Pheochromocytoma

In the adrenal medulla, hormones of "fear and aggression" are normally produced - adrenaline and norepinephrine. Under their influence, the rhythm of the heart, the strength of the contraction of the heart muscle, the lumen of the vessels narrow. If a tumor develops in the adrenal gland or less often outside of them, then it is a disease of the pheochromocytoma. The main feature of hypertension in this endocrine pathology is the presence of crises. In 70% of cases there is no persistent increase in pressure. There are only episodes of a sharp increase in the figures of blood pressure. The cause of such crises is the release of a tumor of catecholamines into the blood. Crisis is accompanied in the classical case by sweating, heart palpitations and a sense of fear.

To confirm the diagnosis, the patient is prescribed a follow-up examination in the form of an analysis of nonmetanephrine and metanephrine in urine or blood. Also, adrenal imaging is performed using ultrasound or computed tomography.

The only effective method of treatment is the operation of tumor removal.

Cushing's Disease and Syndrome

Cushing's disease causes a tumor in the pituitary gland, and the syndrome - in the adrenal gland. The consequence of these diseases is the excessive secretion of glucocorticosteroids( cortisol).As a result, the patient not only activates the sympathetic department of the autonomic nervous system and develops hypertension. Typical are mental disorders, including acute psychosis, cataracts, obesity in the abdomen, trunk, neck, face, acne, bright blush on the cheeks, hirsutism, stretch marks on the skin of the abdomen, muscle weakness, bruising, bone fractures with minimal trauma, menstrual irregularitiesin women, diabetes mellitus.

To clarify the diagnosis, the concentration in the blood of cortisol is measured in the morning and at 21 o'clock, further large and small samples with dexamethasone can be conducted. For the detection of a tumor, magnetic resonance imaging of the pituitary gland and ultrasound or computed tomography of the adrenal glands are performed.

Treatment is preferably performed surgically by removing the neoplasm in the adrenal or pituitary gland. Radiation therapy for Cushing's disease has also been developed. Conservative measures are not always effective. Therefore, drugs play a supporting role in the treatment of Cushing's disease and syndrome.

Primary hyperaldosteronism

Increased secretion of aldosterone in the adrenal glands can be the cause of hypertension. The cause of hypertension in this case is a fluid retention in the body, an increase in the volume of circulating blood. Increased pressure is permanent. The condition is almost not corrected by conventional antihypertensive agents according to standard schemes. This disease is accompanied by muscle weakness, a tendency to convulsions, rapid urination.

To confirm the diagnosis, analyze the content of potassium, sodium, renin, aldosterone in blood plasma. It is also necessary to visualize the adrenal glands.

Treatment of primary aldosteronism is carried out with spironolactone( veroshpiron).Doses of the drug sometimes reach 400 mg per day. If the cause of the disease is a tumor - requires surgical intervention.

Endocrine arterial hypertension has a vivid clinical picture. In addition to hypertension, there are always other signs of an excess of a hormone. The endocrinologist, cardiologist, and surgeon are engaged in problems of diagnostics and treatment of such pathology. Treatment of the underlying disease leads to a complete normalization of the numbers of blood pressure.

Doctor of the endocrinologist Tsvetkova IG.