Arterial hypertension (hypertension, hypertension, hypertension) – a persistent increase in blood pressure from 140/90 mm RT. Art. and higher. 

The most common primary hypertension is a persistent increase in blood pressure (BP), not associated with impaired organs. The diagnosis of primary hypertension is based on the exclusion of all secondary hypertension. 

Secondary hypertension is an increase in blood pressure, which is based on the pathology of one or another organ or system of the body. The causes of secondary hypertension are conditionally divided into renal and endocrine. 

With renal hypertension , a narrowing of the lumen of the renal arteries occurs due to which insufficient blood enters the kidneys. In response to this, substances that increase blood pressure are synthesized by the kidneys. Diseases that can lead to renal hypertension are chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, congenital narrowing of the renal artery. To exclude or confirm renal hypertension, the patient is prescribed a study – a general urinalysis, a urinalysis according to Nechiporenko, a urinalysis according to Zimnitsky, a blood test for urea, creatinine.  

The increase in pressure associated with hormones is endocrine hypertension. With this pathology, high blood pressure and hormones are inextricably linked. At the heart of hypertension is one of the diseases of the endocrine organs (thyroid and parathyroid glands, adrenal glands, pituitary gland). This article will examine in detail the causes of endocrine hypertension.

Hormonal causes of high blood pressure:

• Hyperparathyroidism
• Hypothyroidism
• Thyrotoxicosis.
• Acromegaly.
• Pheochromocytoma.
• Primary hyperaldosteronism.
• Hypercorticism

Hyperparathyroidism

With this disease, there is an increase in the secretion of parathyroid hormone (parathyroid hormone, PTH) by the parathyroid (parathyroid) glands, which leads to increased destruction of bone tissue and an increase in calcium in the blood.

The parathyroid glands are located behind the thyroid gland, their number is often equal to four. The parathyroid glands in the human body regulate calcium-phosphorus metabolism. Normally, there is a clear relationship between blood calcium and parathyroid hormone. For example, if the level of calcium in the blood decreases, the parathyroid glands synthesize more parathyroid hormone. This hormone acts in a special way on bone tissue, “releasing” calcium from it, after which the level of calcium in the blood rises.

There are primary, secondary and tertiary hyperparathyroidism. Elevated pressure is observed with primary and tertiary hyperparathyroidism. Each of the forms of this disease has its own cause of occurrence. So, with primary hyperparathyroidism, the pathological focus is located in one of the parathyroid glands, representing a benign neoplasm (adenoma), which produces PTH uncontrollably and in large quantities. Or, several parathyroid glands undergo hyperplasia – proliferation, and uncontrollably synthesize hormones of the parathyroid glands. With tertiary hyperparathyroidism, a combination of these pathological changes is observed.

Parathyroid hormone, synthesized in large quantities, causes the destruction of bone tissue, followed by the release of large amounts of calcium into the blood. Excess calcium in the blood, in turn, affects the vessels, causing them to narrow. As a result, blood pressure rises. The higher the level of calcium in the blood, the more likely the occurrence of arterial hypertension in humans.

! What other complaints and symptoms can be: weakness, pain in muscles, bones and joints, gait disturbance, urolithiasis, rapid urination, thirst, abdominal pain, nausea, constipation, weakening of memory, depression, psychosis, neurosis, confusion, drowsiness . 

! What kind of examination the doctor will prescribe: a blood test for parathyroid hormone (PTH), total calcium, albumin, ionized calcium, alkaline phosphatase, phosphorus. According to the testimony – ultrasound / CT / MRI / scintigraphy of the parathyroid glands, densitometry (determination of bone density) of the femur, spine and radius. 

Hypothyroidism

With this disease, the level of thyroid hormones – thyroxine and / or triiodothyronine in the blood decreases, or less often – the immunity of organs and tissues of the body to these hormones is formed. There are three forms of hypothyroidism – primary, secondary and tertiary. The most common primary hypothyroidism, the cause of which is an autoimmune lesion of the thyroid gland. Less commonly, primary hypothyroidism occurs in the outcome of inflammatory diseases of the gland, after a surgical operation on the gland, an overdose of certain drugs and toxic substances, or with an initially small volume of the thyroid gland from birth. With secondary and tertiary hypothyroidism, a violation occurs in the brain – the pituitary or hypothalamus (inflammatory diseases and neoplasms of the pituitary, cerebral ischemia, hemorrhage in the pituitary, irradiation of brain tumors). The pituitary gland and hypothalamus are the main “bosses” of the thyroid gland and control its work. The functioning of these structures is disrupted – in response, the thyroid gland is also disrupted.

Arterial hypertension in this disease is characterized by an increase in only diastolic pressure (when indicating blood pressure, two numbers are indicated (for example, 130/80 mmHg): the first digit (130) is systolic pressure, the second (80) is diastolic pressure). The reason for the increase in blood pressure in hypothyroidism is fluid retention in the body, systemic edema of organs and tissues.

! What other complaints and symptoms can be: weakness, drowsiness, forgetfulness, pallor and dryness of the skin, hair loss, decreased body temperature, weight gain with poor appetite, swelling of the face, arms and legs, constipation, menstrual irregularities, impaired speech, decreased hearing loss and difficulty in nasal breathing. 

! What kind of examination the doctor will prescribe: a blood test for TSH, T4 free, T3 free, AT to TPO, AT to TG. According to indications – ultrasound of the thyroid gland. 

Thyrotoxicosis (hyperthyroidism)

Thyrotoxicosis is a condition caused by an increase in thyroxine and / or triiodothyronine in the blood. Thyrotoxicosis occurs when the thyroid gland is strengthened, or because of the destruction of part of the thyroid gland cells with the release of hormones contained in these cells into the blood. An excess of thyroid hormones increases the activity of adrenal hormones – the neurotransmitters adrenaline and norepinephrine, and also increase the susceptibility of the whole organism to the action of these hormones. It is norepinephrine that increases blood pressure, narrowing the blood vessels.

With hyperthyroidism, a characteristic sign is an increase in systolic pressure, while diastolic remains normal.

! What other complaints and symptoms can be: palpitations, heart rhythm disturbances, trembling in the hands and body, insomnia, sweating, distracted attention, irritability, tearfulness, anxiety, weight loss with increased appetite, poor heat tolerance, shortness of breath with little physical exertion, fast fatigue, muscle weakness, frequent unformed stools, menstrual irregularities, brittle nails, hair loss. 

! What examination the doctor will prescribe: a blood test for TSH, T4 free, T3 free. According to the testimony – a blood test for AT to rTTG, AT to TPO, AT to TG, ultrasound and thyroid scintigraphy. 

Acromegaly

With this disease, an increase in the blood of somatotropic hormone (growth hormone) occurs. The cause of the disease is the formation of a hormonally active neoplasm (adenoma) of the pituitary gland – an important endocrine gland located in the brain. This disease occurs in adults when growth zones are already closed. With an excess of growth hormone, hypertrophy (proliferation) of organs and tissues of the body – periosteum, joints and bones, soft tissues, skin, tongue, upper respiratory tract, heart muscle, sweat glands, etc.

The most typical for this disease is a characteristic change in a person’s appearance. Facial features become rougher – lips, nose and ears increase, the bite changes, the face becomes more cheeky, the superciliary arches and chin protrude excessively, the size of the hands and feet increases, the chest becomes wider, the spine is deformed. Characterized by a change in voice, which is becoming more rude.

The increase in blood pressure with acromegaly is due to the influence of growth hormone, which tends to retain sodium in the body. Following sodium retention, water is retained, the volume of extracellular fluid in the body increases, and systemic edema of organs and tissues is formed.

! What other complaints and symptoms can be: increased sweating, increased hair growth on the body, weakness, joint pain, numbness of the extremities, menstrual irregularities in women, decreased potency in men, muscle weakness, development of diabetes mellitus, “oiliness” of the skin, violation cardiac activity – congestive heart failure. 

! What kind of examination the doctor will prescribe: a blood test for IGF-1 (insulin-like growth factor), a blood test for STH (growth hormone) during OGTT (glucose tolerance test). According to indications – MRI of the pituitary gland with contrast. 

Pheochromocytoma

Pheochromocytoma is a neoplasm (often benign) that uncontrollably produces a large amount of the hormones adrenaline and norepinephrine. Most often, such a tumor is detected in the adrenal glands – paired endocrine glands, which are located on the upper poles of the kidneys in the form of “caps”.

Arterial hypertension is the most striking sign of this disease and has its own characteristics. With pheochromocytoma, blood pressure rises suddenly and sharply, the figures of systolic pressure can reach 200-300 mm Hg or more. During such a “crisis”, the patient feels an unaccountable fear, internal trembling, decreased visual acuity, double vision, nausea, sharp pains in the abdomen, heart, headache, lower back pain, there may be vomiting. During a sharp jump in blood pressure, the skin acquires a “marble” pattern, becomes pale, “sweat hail” is characteristic. One of the most frequent manifestations is a frequent pulse of up to 180 beats per minute, heart rhythm disturbance may occur. Sometimes shortness of breath occurs.

A characteristic feature of increasing pressure with pheochromocytoma is the short duration, the attack passes by itself, without the influence of any environmental factors, drugs, etc. A single attack of increasing pressure lasts an average of 15-20 minutes.

! What other complaints and symptoms may be: Between seizures – dizziness, which increases with a change in body position from horizontal to vertical, diabetes, changes in the vessels of the fundus, decreased visual acuity. 

! What kind of examination the doctor will prescribe: analysis of daily urine or blood plasma for methanephrine and normetanephrine. According to the testimony – a blood test for chromogranin A, MRI / CT of the adrenal gland. 

Primary hyperaldosteronism

This is a syndrome based on an increase in blood aldosterone. The cause of primary hyperaldosteronism is a hormone-active tumor of the adrenal cortex, producing aldosterone in excess, or hyperplasia (proliferation) of the cortex of one or both adrenal glands. It is the excess of aldosterone that determines all the signs of this disease. Aldosterone has the ability to retain sodium in the body. Following sodium retention, water retention occurs. The volume of extracellular fluid in organs and tissues, including in the vessel wall, is increasing. Because of this, the lumen of the vessels narrows and blood pressure rises.

High blood pressure in this disease is one of the most persistent symptoms.

Arterial hypertension with hyperaldosteronism can be more or less stable, or occur with crises – episodes of a sharp increase in pressure. It may be mild or more aggressive when traditional therapy aimed at lowering pressure does not help.

! What other complaints and symptoms can be: muscle weakness, cramps, a rare pulse, thirst, frequent and nightly urination. 

! What kind of examination the doctor will prescribe: a blood test for the concentration ratio of aldosterone / renin (APC), a blood test for potassium, sodium. According to indications – MRI / CT of the adrenal glands, catheterization of the adrenal veins with contrast. 

Hypercorticism (Disease and Itsenko-Cushing’s syndrome)

Hypercorticism is a combination of symptoms caused by the prolonged effect of corticosteroids (hormones of the adrenal cortex) on the human body. The reason for the increased secretion of these hormones can be a pituitary gland neoplasm (Itsenko-Cushing’s disease), adrenal cortex neoplasm (Itsenko-Cushing’s syndrome), adrenal cortical hyperplasia, hormone-active tumors of other localizations, as well as the systematic use of steroid hormone preparations.

The most striking manifestation of hypercorticism is a characteristic change in the appearance of a person. Such people are overweight, while fat is deposited mainly in the abdomen, chest, neck, face. In this case, the limbs, on the contrary, “lose weight”. The face is rounded. The skin of the cheeks, chest and back becomes a crimson – cyanotic color. The skin is prone to dryness, the skin is thinned, easily injured, subcutaneous hemorrhages appear. On the chest and limbs, a venous pattern is clearly emerging. Wide stripes appear on the stomach, shoulders, hips, chest – stretch marks, reminiscent of “tongues of flame” of red-violet color. In places of friction on the skin there are foci of hyperpigmentation (darkening). Pustular skin lesions, excessive hair growth on the body, hair loss on the head are characteristic.

Arterial hypertension in patients with hypercorticism occurs in 75-80% of cases and is a constant and characteristic symptom. Steroid hormones play an important role in the regulation of blood pressure. With this disease, high blood pressure and hormones are inextricably linked. With an excessive amount of corticosteroids, the activation of the main body system that controls blood pressure – renin – the angiotensin system, occurs. The vascular tone rises, the volume of circulating blood in the body increases, fluid retention occurs. All this leads to a steadily increased blood pressure.

This disease is characterized by an increase in both systolic and diastolic pressure. Crisis pressure increases are not characteristic. The course of arterial hypertension is severe and rapidly progressing.

! What other complaints and symptoms can be: weakness, menstrual irregularities in women, infertility, decreased potency in men, diabetes mellitus, osteoporosis, muscle weakness, urolithiasis, inflammatory diseases of the urinary system, mental disorders, depression. 

! What kind of examination the doctor will prescribe: a study of saliva for cortisol in the evening, analysis of daily urine for cortisol, a blood test for ACTH and cortisol in the morning and evening. According to the testimony: tests with suppression of cortisol secretion, CT / MRI of the adrenal glands, brain MRI. 

Summing up, it should be noted that secondary endocrine hypertension requires a thorough examination and selection of the optimal treatment on an individual basis. Treatment for high blood pressure is based on the treatment of the disease that is its cause. For treatment, both drug therapy and surgical methods are used.

It is very important to timely identify the disease and begin treatment. Do not forget that the increased pressure every day “paves the way” to other serious and life-threatening diseases. This is myocardial infarction, stroke, atherosclerosis, renal failure, impaired vision, impotence in men. And the sooner the diagnosis is made, the higher the chances of recovery and the lower the risk of complications.

Be healthy!