Which female hormone can increase blood pressure. Hypertension and hormones: how to normalize blood pressure

It is known that arterial pressure may rise or fall due to the level of hormones that it produces thyroid.

Thus, an unstable hormonal background contributes to a change in the strength of heart contractions and vascular tone.

When the functioning of the thyroid gland fails, the patient develops hypothyroidism or hyperthyroidism. Moreover, this condition often accompanies hypertension or hypotension.

If the hormone is produced in excess or in short supply, then the patient will always feel unsatisfactory and there will be many complications associated with internal organs.

In addition, these patients have reduced life expectancy. But with the normalization of thyroid function, the patient's condition improves, and the pressure returns to normal.

The thyroid gland is a component of the endocrine system, the organs of which must work in concert. Therefore, changes in the functioning of even one organ are reflected in the rest.

It is worth noting that the pressure is coordinated by the endocrine system. Within its limits, the thyroid gland interacts with:

1. pituitary, hypothalamus and epiphysis;
2. parathyroid glands;
3. adrenal glands;
4. pancreas;
5. ovaries and testicles;
6. apudocytes scattered throughout the body.

Apudocytes are cells that regulate hormonal levels at the local level. They are found in every organ, including those that are not related to the endocrine system (lungs).

In addition, the thyroid gland is associated with immune system. Therefore, the changes that occur in its activity are reflected first on the adrenal glands, and then on the thymus gland.

The coordination of all glands is carried out through rapid chemical reactions. The thyroid gland is a glandular tissue, its cells can synthesize substances with strong chemical activity.

Thyroid hormone is released into the bloodstream, and then, along with the blood stream, is carried throughout the body. In addition, the thyroid gland has an extensive network of lymphatic and blood vessels, so the hormonal concentration changes very quickly.

Each cell in the body has specific receptors that respond to a particular hormone. Therefore, when the hormonal level changes, some physiological processes are triggered.

Follicular cells of the thyroid gland produce two types of chemically active elements:

• T3 - triiodothyronine;
• T4 - thyroxine.

T3 and T4 - substances that help to adapt to adverse conditions environment. When the hormone thyroxine or triiodothyronine is normal, it maintains homeostasis.

However, in diseases of the thyroid gland, their concentration greatly increases or decreases. In this case, he cannot adapt, as a result of which he is faced with various concomitant diseases. It is worth noting that for those who refuse therapy, the prognosis for recovery becomes unfavorable.

In addition, with hormonal failure, hypotension or hypertension may develop. Subsequently, against their background, a thyrotoxic crisis often appears, which can end lethal outcome or fatal myxedema coma.

According to approximate data arterial hypertension observed in 20-30% of adults. And chronic hypertension is diagnosed in 60% of the elderly population. Of all cases of the presence of such a disease, approximately 0.3% of patients are provoked by a malfunction of the thyroid gland.

When the hormone thyroxine and triiodothyronine are normal, then its content increases only under stress, low temperature and physical activity. And if the thyroid gland produces an excessive amount of T4 and T3 without visible reasons This condition is called hyperthyroidism.

Thyroid hormone can have both negative and beneficial effects on the body. So, it increases blood pressure due to the fact that the heart begins to contract more intensively, the lumen of the arteries narrows, and the vessels become toned.

Functional Consistency of cardio-vascular system and the thyroid gland is necessary to quickly draw attention to malfunctions in their work and carry out adequate treatment. So, an excess of hormones increases blood pressure, provoking the development of hypertension and tachycardia.

In this condition, the following symptoms are noted:

1. fainting;
2. discomfort in the area of ​​the heart;
3. malaise;
4. dizziness.

At the same time, the patient suffers from severe headaches. Receiving a persistent migraine often leads to a complete loss of performance.

In addition, when thyroid hormone predominates, blood rushes to the body, as a result of which its temperature rises to 36.8 ° C. Thermoregulation is necessary when the ambient temperature is lower, for example, in winter. It is noteworthy that during the course of hyperthyroidism, subfebrile temperature is always noted.

In addition, thyroid hormone increases blood pressure, helping to activate the blood supply to the brain, so it works intensively. At the same time, reactions, attention and memory become aggravated, mental processes proceed quickly, and the level of wakefulness increases.

These changes are useful when you need to respond to a conflict, stimulus, or environmental threat. However, in the case of a constant excess of hormones, negative reactions such as:

• inappropriate behavior;
• irritability;
• emotional lability;
• anxiety.

As a result, panic attacks may appear.

Thyroid hormone also increases muscle tone, lowering the seizure threshold. So, at a low ambient temperature, muscle trembling contributes to warming.

If the increase in the concentration of T4 or T3 was facilitated by stressful conditions, and not by hypothermia, then the rush of blood to the muscles gives more physical strength, for example, for running.

However, in the presence of hyperthyroidism, this mechanism leads to the development of unpleasant consequences:

1. indigestion;
2. myalgia;
3. psychomotor overexcitation;
4. convulsions.

In addition, thyroid hormone increases appetite. When metabolic processes are accelerated, a person needs to eat more food. So, after increased physical activity or hypothermia, saturation of the body with food helps to renew strength, but in the presence of hyperthyroidism this does not lead to good health.

When overeating, the patient's weight does not increase, but a number of adverse reactions: vomiting, nausea and heartburn. Thus, if the diet is not followed, excessive food intake, together with a failure in lipid metabolism, can lead to the appearance of atherosclerosis. In addition, the abuse of sweets in violation carbohydrate metabolism contributes to the development of diabetes.

Thyroid hormones greatly affect metabolism. Failures in metabolic processes lead to early wear of the myocardium, making the walls of blood vessels more fragile.

It is worth noting that with hyperthyroidism, the likelihood of developing a heart attack, heart failure and stroke increases significantly. Therefore, in order to avoid death, it is necessary to carry out timely treatment of the disease.

Hormones that lower blood pressure

In some cases, in order to normalize well-being, you need to reduce body temperature and pressure. The following factors require some adaptation:

• lack of water or food;
• heat;
• weakness after illness;
• lack of oxygen, for example, in high mountain areas;
• severe intoxication;
• big blood loss.

In such cases, the level of production of TK and T4 decreases. Normally, this condition is short-lived, so it does not harm the body.

However, in chronic hypothyroidism, the patient's health suffers significantly. Its level of blood pressure decreases, vascular tone decreases, and the heart begins to work more slowly, as a result of which oxygen starvation occurs in the tissues. In the presence of hypothyroidism, a number of unpleasant complications develop - vegetovascular dystonia, bradycardia, angina pectoris and arrhythmia.

First of all, the brain suffers from a lack of nutrients and oxygen. At the same time, cognitive abilities and memory deteriorate.

Hypothyroidism makes a person distracted and inhibited, his performance decreases, drowsiness and weakness appear. A depressive state also occurs, which over time flows into a more significant complication - clinical depression. The most negative consequence of this condition is suicide.

In addition, untreated hyperthyroidism can lead to myxedematous coma. In the chronic course, this disease is accompanied by symptoms such as fainting, headache, dizziness and malaise. And when severe course illness is assigned a disability.

Slow metabolism contributes to loss of appetite and digestive disorders. Stagnant conditions occur in tissues and organs, so nausea, vomiting and swelling occur.

With the course of hypothyroidism, body weight becomes greater, as a result of which obesity appears, which affects the work of blood vessels and the heart.

It is worth noting that with a pronounced form of the disease, the body temperature drops to 36.4 to 34.2°C. It is this indicator that indicates disruptions in the hormonal background, which requires an immediate appeal to the endocrinologist. A cardiologist should deal with the protection of the cardiovascular system.

Thyroid treatment

In order for hypertension or hypotension, accompanied by a headache, to disappear, and to stabilize the functioning of the thyroid gland, the first thing to do is to review the diet. So, in food you should eat foods rich in iodine:

1. sea ​​fish and seafood;
2. feijoa;
3. seaweed;
4. persimmon;
5. bell pepper;
6. nuts.

The amount of such food should not be excessive, because the body needs no more than 150-200 mg of iodine per day. It is worth noting that folk remedies(Lugol's solution, iodine) is better not to use, as you can oversaturate the body with this microelement.

Due to the fact that the symptoms of thyroid disorders are similar to other boards of various diseases, one of which is arterial hypertension, a certain test can be performed. So, an iodine grid should be made on the arm, after which this place cannot be wetted, but you need to watch it.

If after 24 hours the iodine does not disappear, then the body is not deficient in iodine, which indicates the absence of problems with the thyroid gland. But if after 5-6 hours the grid disappears, then this indicates a lack of iodine and poor functioning of the thyroid gland.

In this case, you need to go to the endocrinologist, who will prescribe a special treatment and prescribe the intake of iodine-containing drugs. A specialist in the video in this article will tell you how to treat the thyroid gland.

Regulatory influence of the central nervous system on the state of vascular tone is carried out by closely intertwined interactions of nervous and hormonal factors.
System blood circulation constantly adapts to the needs of individual organs and tissues by expanding or narrowing individual sections of blood vessels. This complex adaptive function of the circulatory system is carried out by the neurohormonal pathway, the influence of the hypothalamus on the pituitary gland, followed by the mobilization of adrenal hormones. The hypothalamus has a distinct direct effect on vascular tone. Experimental studies have shown that pressor points are located in the posterior nuclei of the hypothalamus, the destruction of which is accompanied by a persistent decrease in blood pressure, and irritation causes an increase in pressure.

Apart from immediate influence, the hypothalamus also has an indirect effect on vascular tone by mobilizing pituitary hormones. The direct anatomical and functional connection with the neurohypophysis provides, when it is stimulated, the rapid release of vasopressin, and through the sympathetic nervous system it provokes an increased secretion of catecholamines. These hormonal shifts can have a direct effect on vascular tone. Simultaneously, there is also stimulation of the secretion of hormones of the adenohypophysis with an increased release of ACTH, which provokes the secretion of corticosteroids.

Thus, the main endocrine the regulator of all vascular reactions and vascular tone is the pituitary-adrenal system, which carries out all adaptive reactions in the body. The highest department that controls the function of the pituitary-adrenal system, of course, is the cerebral cortex. Emotional arousal, stressful situations, overstrain of nervous processes have a stimulating effect on the functional state of the hypothalamic-pituitary system and provoke an increased release of ACTH and adrenal hormones (Euler et al., 1959). An increase in ACTH secretion under the influence of emotional arousal has been established by many researchers (N. V. Mikhailov, 1955; I. A. Eskin, 1956; Harris, 1955; Liebegott, 1957). Increased release of catecholamines in these situations has been proven by numerous works by Selye (1960), Rabb (1961) and many others.

In implementation adaptive vascular reactions, the leading role is played by both the hormones of the adrenal medulla (adrenaline and noradrenaline) and the cortical hormones (cortisol, aldosterone).

Both hormones adrenal medulla affect blood pressure in different ways. will increase blood pressure mainly due to increased work of the heart, minute volume, pulse rate. Norepinephrine, which is formed at the nerve endings, has a direct effect on vascular tone. The pressor effect of norepinephrine is much stronger than that of adrenaline (VV Zakusov, 1953). By acting directly on vasoconstrictors, norepinephrine increases both systolic and diastolic blood pressure. An increase in the secretion of catecholamines is almost always due to the influence of the central nervous system, which is affected by factors external environment, causing emotional arousal or nervous overstrain, which entails a number of vascular reactions carried out through the hypothalamic-pituitary system. The transmission of pressor impulses to the periphery is realized through the release of norepinephrine at the nerve endings embedded in the walls of blood vessels.

Increased selection norepinephrine can cause very rapid vasoconstriction, up to a complete cessation of blood flow. Many studies have established that the norepinephrine formed at the nerve endings is very quickly subjected to enzymatic influences and inactivated. Under physiological conditions, this inactivation occurs almost instantly (after 4-6 seconds) after injection (Gitlov et al., 1961). V pathological conditions not only secretion, but also inactivation of norepinephrine can be disturbed.

Impact hypothalamus on vascular tone is not limited only to the mobilization and increase in the secretion of catecholamines, there is also a stimulation of the secretion of hormones of the adrenal cortex. The influence of the hypothalamus on the release of cortical hormones occurs due to the increased release of ACTH, through increased release in nucl. supraopticus and para-vertebralis of a substance (neurohormone) called CRF.
CRF application point are basophilic cells of the adenohypophysis that produce ACTH, which in turn increases the production of glucocorticoids.

In a relationship effects on vascular tone hormones of the cortical and medulla of the adrenal glands function as a whole. According to Raab, the pressor effect of corticosteroids is carried out by increasing the sensitivity of the vascular wall to the effects of catecholamines. This position has been confirmed by many researchers.

Significantly more pronounced effect on vascular tone have mineralocorticoids, in particular aldosteroi, the secretion of which is partly stimulated by ACTH. The main stimulator of aldosterone production is a special hormone-like substance discovered by Farrell in 1960 in the hypothalamus and named by him, by analogy with tropic hormones, adrenoglomerulotropin. The introduction of this substance causes hyperplasia of the cells of the glomerular zone of the adrenal cortex and significantly increases the secretion of aldosterone. The centrogenic mechanism is not the only regulator of the formation and release of aldosterone. Currently, a lot of data has been obtained indicating that renin and its derivative angiotensin II have a pronounced stimulating effect on aldosterone secretion. Sloper (1962) found that the introduction of renin or angiotensin II is accompanied by an increased formation of aldosterone and a simultaneous increase in blood pressure.

Action aldosterone for blood pressure It is carried out by increasing the reabsorption of sodium in the renal tubules and increasing its level in the blood. Sodium, apparently, also lingers in the walls of blood vessels, contributing to an increase in their tone and the development of hypertension (N. A. Ratner and E. N. Gerasimova, 1966). Violation of electrolyte metabolism, according to Selye (1960), makes the body particularly sensitive to all hypertensive effects.

Certain influence Other mineralocorticoids also have an effect on vascular tone. Administration of deoxycorticosterone acetate (DOXA) to animals causes persistent hypertension, which persists even after removal of the adrenal glands (Friedman, 1953). This is also evidenced by the data of Hudson (1965). Glucocorticoids also have some effect on vascular tone.

Based on literature data it can be concluded that adrenal hormones are directly involved in the regulation of vascular tone. The leading role of endocrine factors in this regard is proved by the existence of purely endocrine cases of hypertension, which are, as it were, a natural experiment proving that an increase in the secretion of certain hormones in hormonally active tumors of the adrenal glands can be achieved. cause marked and persistent hypertension. These “purely endocrine” hypertensions include hypertension in Itsenko-Kushipg syndrome, pheochromocytoma, and primary aldosteronism.

There are two types of arterial hypertension - primary and secondary (hypertension 1 and hypertension 2).

Primary hypertension (hypertension 1) is an independent disease that is not associated with a malfunction of the organs of the human body. This type is called hypertension. .

Secondary hypertension (hypertension 2) is considered to be an increase in blood pressure under the influence of a malfunction of some organs (for example, kidneys, thyroid gland).

Identification and elimination of these disorders leads to the normalization of blood pressure. .

When a patient complains of high blood pressure, the doctor prescribes general analysis blood, determination of glucose, potassium, urea, creatinine, cholesterol, ECG, chest X-ray, examination of the fundus, ultrasound of the abdominal organs. If at this stage there is no reason to suspect secondary hypertension and it is possible to achieve pressure reduction with standard therapy, then the examination can be completed.

In patients older than 40 years, secondary hypertension occurs in 10% of cases, 30-35 years old - in 25%, younger than 30 - in almost 100% of cases.

If secondary hypertension is suspected, targeted laboratory research. We identify the causes of arterial hypertension, prescribe tests:

Hypertension of renal origin. Bound to defeat renal arteries, narrowing their lumen. The kidneys do not receive enough blood and they produce substances that increase blood pressure. .

• - In chronic glomerulonephritis (chronic inflammation in the glomeruli of the kidneys).
• - In chronic pyelonephritis (inflammatory infection kidneys).
• - With a polycystic kidney - the degeneration of the tissue (parenchyma) of the kidney into multiple cysts.
• - With congenital narrowing of the renal artery.

Urinalysis, urinalysis according to Nechiporenko, urinalysis according to Zimnitsky, blood test for urea, creatinine, bacteriological culture of urine are prescribed.

Hypertension of hormonal origin. The cause is pathology:

• - Itsenko-Cushing's disease.
• - Pheochromocytoma.
• - Kohn's syndrome(hyperaldosteronism) .
• - Hypothyroidism, hyperthyroidism.
• - Diabetic glomerulosclerosis with diabetes- changes in the capillaries of the renal glomeruli, leading to renal failure, edema and arterial hypertension .
• - Acromegaly.

Itsenko-Cushing's disease is associated with damage to the adrenal cortex (a pair of small endocrine glands located above the kidneys). This dramatically increases hormone levels. ACTH and cortisol. The disease is accompanied by obesity, acne, hair loss on the head and hair growth on the limbs, arterial hypertension, heart failure, and increased blood sugar levels. This condition may also develop long-term treatment corticosteroid drugs (for example, in bronchial asthma, rheumatoid arthritis).

For diagnosis, tests for cortisol and ACTH (adrenocorticotropic hormone) are prescribed. You can read more about Itsenko-Cushing's disease and hormones (ACTH, cortisol) in the articles at the links.

Pheochromocytoma. This is a tumor of the adrenal glands (mostly benign) that produces an excess amount of hormones. epinephrine and norepinephrine. Usually, blood pressure rises suddenly and sharply, accompanied by trembling, sweating, and increased blood sugar levels.

For diagnosis, tests for adrenaline, norepinephrine, dopamine are prescribed. About pheochromocytoma, about adrenaline and norepinephrine, read the articles on the links.

Kohn's syndrome or hyperaldosteronism. This disease is associated with the presence of a tumor (usually benign) of the zona glomeruli of the adrenal glands, where the hormone is produced. aldosterone. The hormone intensively enters the bloodstream, accumulates water and sodium in the wall of blood vessels, narrows their lumen, and this leads to an increase in blood pressure. At the same time, potassium is excreted from the body, which leads to disorders in the functioning of muscles, including the heart. The work of the kidneys is disrupted.

Assign tests for aldosterone, potassium, sodium. The hormone aldosterone and Kohn's syndrome are also described in the referenced articles.

Acromegaly is a disease caused by excess production of growth hormone ( growth hormone). People of any age get sick. The size of the hands and feet increases, facial features are enlarged. Headaches, impaired functioning of the joints and internal organs, increased fatigue, increased blood pressure.

For diagnosis, an analysis is prescribed for somatotropic hormone.

Hypertension in violation of the functions of the thyroid gland.

• - Hyperthyroidism (increased thyroid hormones). A characteristic feature is high systolic pressure with normal diastolic pressure.
• - Hypothyroidism (lowered thyroid hormone levels). A characteristic feature is high diastolic pressure .

To identify the pathology and causes of hypertension, tests for thyroid hormones T3, T4 free, TSH are prescribed.

Blood pressure depends on the level.

Fluctuations in the hormonal background lead to a change in vascular tone and the strength of heart contractions.

If the thyroid gland is disturbed, the patient is faced with hyperthyroidism or hypothyroidism, and then the condition is aggravated by hypotension or hypertension.

Without a corresponding medical care both pathologies cause poor health and many complications to third-party organs.

The victim loses his ability to work, and his life time is reduced. Normalization of the thyroid gland helps to eliminate problems with pressure.

Qualified assistance is provided by two specialists: an endocrinologist and a cardiologist.

What is the relationship between blood pressure and hormonal levels?

The thyroid gland is part of the endocrine system. The organs of the endocrine system work in a coordinated mode, changes in the work of one organ immediately affect the work of the others.

Blood pressure is regulated endocrine system.

To prevent colossal damage to health, it is important to immediately consult a doctor. As part of the endocrine system, the thyroid gland interacts with:

• with the pituitary gland, epiphysis and hypothalamus;
• with adrenal glands;
• with testicles or with ovaries;
• with the pancreas;
• with parathyroid glands;
• with apudocytes scattered throughout the body.

Apudocytes are cells that carry out local regulation of the hormonal background. They are found in all organs, even in those that do not belong to the endocrine system (for example, in the lungs).

In addition, the thyroid gland is closely related to the immune system, and any changes in its activity first affect the adrenal glands, and then the thymus gland.

The coordination of the glands is carried out by instantaneous chemical reactions.

The thyroid gland consists of glandular tissue, the cells of which are capable of synthesizing substances with high chemical activity.

How Hormones Raise Blood Pressure and Cause Hypertension

It is estimated that 20-30% of the surveyed adult population suffers from hypertension.

More than 60% deal with chronic hypertension.

Of all cases of chronic hypertension, about 0.3% is caused precisely by disorders in the thyroid gland.

Normally, T3 and T4 increase during stress, during exercise, at low ambient temperatures.

A condition in which the thyroid gland produces excessive amounts of T3 and T4 is called hyperthyroidism.

What are the positive and negative effects of high levels of thyroid hormones:

1. Blood pressure rises. The heart contracts more strongly, the blood vessels become toned, the lumen of the arteries becomes narrow.

The mechanism of coordinated work of the thyroid gland, heart and blood vessels is needed so that a person can instantly respond to a dangerous situation.

With a chronic excess of hormones, hypertension, hypertension, and tachycardia develop.

In addition, there are pains in the heart, dizziness, weakness and fainting.

The patient suffers from excruciating headaches. Regular migraines can lead to loss of performance.

1. Blood rushes to the surface of the body, body temperature exceeds 36.8°C. Thermoregulation helps to survive if the ambient temperature is not high enough, for example, during the cold season.

In patients with hyperthyroidism, it is noted constantly.

1. The blood supply to the brain is increased, the organ starts to work in the active mode. Memory, attention and reactions are sharpened.

The level of wakefulness increases, mental processes proceed faster.

Such changes become useful if you need to respond to some kind of stimulus, conflict or threat from the outside world.

But with a chronic overabundance of hormones, this mechanism can cause irritability, anxiety, emotional lability and inappropriate behavior.

Ultimately, patients experience panic attacks.

1. Muscles get toned, the threshold for convulsive readiness decreases. If the ambient temperature is low, muscle shivering helps keep you warm.

If the increase in T3 or T4 is not caused by hypothermia, but by stress, then the rush of blood to the muscles makes it possible to hit or run (the “fight or flight” reaction).

In hyperthyroidism, this mechanism leads to myalgia, convulsions, psychomotor overexcitation, and indigestion.

1. Appetite increases. With an accelerated metabolism, you need to absorb a large amount of food.

With hypothermia or after exercise, appetite helps to return to normal, but with hyperthyroidism this does not contribute to satisfactory well-being.

As a result of overeating, the patient does not gain weight, but is faced with nausea, heartburn and vomiting.

If he does not follow a diet, then overeating in conjunction with a violation of lipid metabolism can cause atherosclerosis.

And the abuse of sweets against the background of impaired carbohydrate metabolism can cause diabetes.

Thyroid hormones have a huge impact on metabolism. Metabolic disorders can lead to premature wear of the heart muscle, to the fragility of the walls of blood vessels.

Patients with hyperthyroidism are at high risk of heart attack, stroke, or heart failure. Elimination of hyperthyroidism helps to avoid premature death.

How hormones lower blood pressure and cause hypotension

In some cases, for normal health, it is necessary to lower body temperature and blood pressure.

What factors require such adaptation:

• heat;
• lack of oxygen, for example, in high mountain areas;
• massive blood loss;
• severe poisoning;
• weakened state after illness;
• lack of food or water.

Under these conditions, the thyroid gland reduces the level of T3 and T4 in the blood. Normally, such a decrease does not last long and does not cause serious harm.

But chronic hypothyroidism is accompanied by significant damage to the body:

1. Blood pressure drops, the heart works more slowly, vascular tone decreases. The tissues begin to experience oxygen starvation.

With hypothyroidism, bradycardia, arrhythmia, angina pectoris, vegetovascular dystonia and many other complications occur.

1. The brain suffers from a lack of oxygen and nutrients first. The patient's memory and cognitive abilities are deteriorating.

With hypothyroidism, the victim becomes inhibited and distracted.

1. There is weakness and drowsiness, performance decreases. A depressive syndrome is formed, flowing into major clinical depression.

The consequences of this condition are unpredictable, even suicide is possible.

Lack of motivation for treatment in hypothyroidism causes myxedematous coma.

1. Low blood pressure accompanied by headaches, weakness, dizziness and fainting. Disability is assigned to patients with severe hypothyroidism.
2. Slowdown of metabolism leads to loss of appetite and indigestion. Stagnation begins in organs and tissues, patients complain of swelling, vomiting and nausea.

With hypothyroidism, body weight increases, obesity develops. Obesity, in turn, affects the heart and blood vessels.

With severe hypothyroidism

body temperature is reduced to 36.4 - 34.2°C.

According to this indicator, the patient can easily suspect a hormonal imbalance and turn to an endocrinologist. It is up to the cardiologist to decide how to protect the heart and blood vessels.

Recovery prognosis

Modern drugs are able to regulate the level of T3 and T4 and reduce the likelihood of complications in thyroid diseases.

Hypothyroidism or hyperthyroidism occurs for various reasons, the treatment is prescribed depending on the diagnosis.

Even in the most unfavorable case, with toxic or malignant neoplasms of the thyroid gland, the patient has a chance of recovery if he immediately consults a doctor.

You may be interested in:

fluctuations TSH level with hypothyroidism
What causes thyromegaly in children?
Signs if the thyroid gland is enlarged

In today's article, we will discuss problems that relate to the endocrine causes of hypertension, i.e., blood pressure rises due to the excessive production of some hormone.

Article outline:

1. First, we will list the hormones that can cause problems, and you will find out what role they play in the body when everything is normal.
2. Then we will talk about specific diseases that are included in the list of endocrine causes of hypertension.
3. And most importantly - we will give detailed information about the methods of their treatment.

I have made every effort to explain complex medical problems in simple terms. I hope to make it more or less successful. Information on anatomy and physiology in the article is presented in a very simplified way, not detailed enough for professionals, but for patients - just right.

Pheochromocytoma, primary aldosteronism, Cushing's syndrome, thyroid problems, and other endocrine diseases cause hypertension in about 1% of patients. These are tens of thousands of Russian-speaking patients who can be completely cured or at least alleviate their hypertension if intelligent doctors take care of them. If you have hypertension due to endocrine causes, then without a doctor you will definitely not cure it. Moreover, it is extremely important to find a good endocrinologist, and not be treated by the first one that comes across. You will also need general information about the methods of treatment, which we present here.

Glands and hormones that interest us

The pituitary gland (synonym: pituitary gland) is a rounded gland located on the lower surface of the brain. The pituitary gland produces hormones that affect metabolism and, in particular, growth. If the pituitary gland is affected by a tumor, then this causes an increased production of some hormone inside it, and then “along the chain” in the adrenal glands, which it controls. A pituitary tumor is often the endocrinological cause of hypertension. Read the details below.

The adrenal glands are glands that produce various hormones, including catecholamines (adrenaline, norepinephrine, and dopamine), aldosterone, and cortisol. There are 2 of these glands in humans. They are located, as you might guess, on top of the kidneys.

If a tumor develops in one or both adrenal glands, then this causes an excessive production of some hormone, which, in turn, causes hypertension. Moreover, such hypertension is usually stable, malignant and not amenable to treatment with pills. The production of certain hormones in the adrenal glands is controlled by the pituitary gland. Thus, there are not one, but two potential sources of problems with these hormones - diseases of both the adrenal glands and the pituitary gland.

Hypertension can be caused by overproduction of the following hormones in the adrenal glands:

• Catecholamines - adrenaline, norepinephrine and dopamine. Their production is controlled by adrenocorticotropic hormone (ACTH, corticotropin), which is produced in the pituitary gland.
• Aldosterone is produced in the glomerular zone of the adrenal cortex. Causes salt and water retention in the body, also enhances the excretion of potassium. Increases the volume of circulating blood and systemic arterial pressure. If there are problems with aldosterone, then edema, hypertension, sometimes congestive heart failure, and weakness due to low levels of potassium in the blood develop.
• Cortisol is a hormone that has a multifaceted effect on metabolism, preserving the energy resources of the body. Synthesized in the outer layer (cortex) of the adrenal glands.

The production of catecholamines and cortisol occurs in the adrenal glands under the control of the pituitary gland. The pituitary gland does not control the production of aldosterone.

Adrenaline is the hormone of fear. Its release occurs during any strong excitement or sudden physical exertion. Adrenaline saturates the blood with glucose and fats, increases the absorption of sugar from the blood by cells, causes vasoconstriction of the abdominal organs, skin and mucous membranes.

Norepinephrine is the rage hormone. As a result of its release into the blood, a person becomes aggressive, significantly increases muscle strength. The secretion of norepinephrine increases with stress, bleeding, severe physical work and other situations requiring rapid restructuring of the body. Norepinephrine has a strong vasoconstrictive effect and plays a key role in the regulation of the rate and volume of blood flow.

Dopamine causes an increase in cardiac output and improves blood flow. From dopamine, under the action of enzymes, norepinephrine is produced, and from it already adrenaline, which is final product biosynthesis of catecholamines.

So, we figured out a little with hormones, now we list directly endocrine causes of hypertension:

1. Pheochromocytoma is a tumor of the adrenal glands that causes increased production of catecholamines. In 15% of cases, it happens not in the adrenal glands, but in the abdominal cavity or chest.
2. Primary hyperaldosteronism is a tumor in one or both adrenal glands that causes too much aldosterone to be produced.
3. Itsenko-Cushing syndrome, also known as hypercortisolism, is a disease in which too much cortisol is produced. In 65-80% of cases it is due to problems with the pituitary gland, in 20-35% of cases it is due to a tumor in one or both adrenal glands.
4. Acromegaly is an excess of growth hormone in the body due to a tumor in the pituitary gland.
5. Hyperparathyroidism is an excess of parathyroid hormone (parathyroid hormone) produced by the parathyroid glands. Not to be confused with the thyroid gland! Parathyroid hormone increases the concentration of calcium in the blood due to the fact that it washes this mineral from the bones.
6. Hyper- and hypothyroidism - high or low levels of thyroid hormones.

If you do not treat the listed diseases, but simply give the patient pills for hypertension, then usually this does not allow you to sufficiently reduce the pressure. To bring the pressure back to normal, to avoid a heart attack and stroke, you need the participation in the treatment of a whole team of competent doctors - not just an endocrinologist, but also a cardiologist and a surgeon with golden hands. Good news: over the past 20 years, the possibilities of treating hypertension caused by endocrine causes have expanded significantly. Surgery has become much safer and more efficient. In some situations, timely surgical intervention allows you to normalize the pressure so much that you can cancel the constant intake of tablets for hypertension.

The problem is that all the diseases listed above are rare and complex. Therefore, it is not easy for patients to find doctors who can treat them conscientiously and competently. If you suspect that you have hypertension due to an endocrine cause, then keep in mind that the endocrinologist on duty at the clinic will probably try to kick you off. He does not need your problems either for money, much less for nothing. Look for an intelligent specialist in the reviews of friends. Surely it will be useful to go to the regional center, and even to the capital of your state.

The following is detailed information that will help you understand the course of treatment: why this or that event is carried out, medications are prescribed, how to prepare for surgery, etc. Note that to date, not a single major serious study has been conducted among patients with endocrine hypertension, which would meet the criteria of evidence-based medicine. All the information about the methods of treatment, which is published in medical journals, and then in books, is collected “from the world by a string”. Doctors exchange experience with each other, gradually generalize it, and this is how universal recommendations appear.

Pheochromocytoma is a tumor that produces catecholamines. In 85% of cases, it is found in the adrenal medulla, and in 15% of patients - in the abdominal cavity or chest. It is extremely rare for a catecholamine-producing tumor to occur in the heart, bladder, prostate, pancreas or ovaries. In 10% of patients, pheochromocytoma is a hereditary disease.

Usually this benign tumor, but in 10% of cases it turns out to be malignant and metastasizes. V? cases, it produces adrenaline and norepinephrine, in? cases - only norepinephrine. If the tumor turns out to be malignant, then dopamine can also be produced. Moreover, there is usually no relationship between the size of a pheochromocytoma and how abundantly it produces hormones.

Among all patients with arterial hypertension, approximately 0.1-0.4%, i.e., 1-4 patients out of 1000, have pheochromocytoma. In this case, the pressure can be constantly elevated or attacks. The most common symptoms are headache, sweating, and tachycardia (palpitations). If blood pressure is elevated but these symptoms are absent, then pheochromocytoma is unlikely to be the cause. There are also hand tremors, nausea, vomiting, visual disturbances, attacks of fear, sudden pallor or, conversely, reddening of the skin. Approximately at? Patients appear to have stable or occasionally elevated blood glucose levels and even sugar in the urine. At the same time, the person inexplicably loses weight. If the heart is affected due to an increased level of catecholamines in the blood, symptoms of heart failure develop.

The frequency of the main symptoms in pheochromocytoma

It happens that pheochromocytoma occurs without severe symptoms. In such cases, the main complaints from patients are signs of tumor growth, i.e. pain in the abdomen or chest, a feeling of fullness, squeezing of internal organs. In any case, to suspect this disease, it is enough to simultaneously detect hypertension, high blood sugar and signs of an accelerated metabolism against the background of normal level thyroid hormones.

Diagnostics

Symptoms of pheochromocytoma are not unambiguous, they are different for different patients. Therefore, it is impossible to make a diagnosis only on the basis of visual observation and listening to patient complaints. It is necessary to look for and identify biochemical signs of increased production of adrenaline and norepinephrine. These hormones are excreted in the urine as compounds of vanillin-mandelic acid, metanephrines (methylated products), and free catecholamines. The concentration of all these substances is determined in daily urine. This is the standard diagnostic procedure for suspected pheochromocytoma. Before taking tests in advance, patients need to stop taking medications that increase or, on the contrary, inhibit the production of catecholamine hormones in the body. These are the following drugs: adrenoblockers, adrenostimulants, including central action, MAO inhibitors and others.

If possible, then compare the content of catecholamine metabolism products in the urine in a normal situation and immediately after a hypertensive crisis. It would be nice to do the same with blood plasma. But for this, blood would have to be taken through a venous catheter, which must be installed 30-60 minutes in advance. It is impossible to keep the patient at rest all this time, and then to have a hypertensive crisis on schedule. A blood test from a vein is itself stressful, which increases the concentration of adrenaline and norepinephrine in the blood and thus leads to false positive results.

Also, for the diagnosis of pheochromocytoma, functional tests are used, in which they inhibit or stimulate the secretion of catecholamines. The production of these hormones can be inhibited with the help of the drug clonidine (clophelin). The patient donates blood for analysis, then takes 0.15-0.3 mg of clonidine, and then donates blood again after 3 hours. Compare the content of adrenaline and norepinephrine in both analyses. Or they check how taking clonidine suppresses the nocturnal production of catecholamines. To do this, do tests of urine collected during the night period. In a healthy person, after taking clonidine, the content of adrenaline and noradrenaline in night urine will significantly decrease, but in a patient with pheochromocytoma it will not.

Stimulation tests have also been described in which patients receive histamine, tyramine, and best of all, glucagon. From taking stimulant drugs in patients with pheochromocytoma, blood pressure rises significantly, and the content of catecholamines increases several times, much stronger than in healthy people. To avoid a hypertensive crisis, patients are first given alpha-blockers or calcium antagonists. These are drugs that do not affect the production of catecholamines. Stimulation tests can only be used with great caution, because there is a risk of provoking a hypertensive crisis and a cardiovascular catastrophe in a patient.

The next step in the diagnosis of pheochromocytoma is to identify the location of the tumor. For this, computed tomography or magnetic resonance imaging is performed. If the tumor is in the adrenal glands, then it is usually easily detected, often even with the help of ultrasound, which is the most accessible examination. But if the tumor is located not in the adrenal glands, but somewhere else, then whether it can be detected depends largely on the experience and will to win that the doctor will show. As a rule, 95% of pheochromocytomas are found in the adrenal glands if their size is more than 1 cm, and in the abdominal cavity if they are more than 2 cm.

If using computed tomography or magnetic resonance imaging could not detect a tumor, then you have to do a radioisotope scan using a contrast agent. A substance that emits radioactivity is injected into the patient's bloodstream. It spreads throughout the body, “illuminates” the vessels and tissues from the inside. Thus, the X-ray examination is more informative. Metaiodobenzylguanidine is used as a contrast agent. Radioisotope scanning using a contrast agent can cause kidney failure and has other risks as well. Therefore, it is appointed only in exceptional cases. But if the benefit is higher than the potential risk, then you need to do it.

They can also test for catecholamines in the blood that flows from the place where the tumor is located. If the definition of this place was not mistaken, then the concentration of hormones will be several times higher than in the blood taken from other vessels. Such an analysis is prescribed if pheochromocytoma is found in the adrenal glands. However, this is a complex and risky analysis, so we try to do without it.

Treatment

For the treatment of pheochromocytoma, a surgical operation is performed to remove the tumor, if there are no contraindications to it. The good news for patients is that in recent years surgeons have introduced laparoscopy. This is a method of performing operations in which the incision on the skin is very small and minimal damage is also caused inside. Thanks to this, recovery takes no more than 2 weeks, and before it was an average of 4 weeks. After surgery, more than 90% of patients have a persistent decrease or even complete normalization of blood pressure. Thus, the effectiveness of surgical treatment of pheochromocytoma is very high.

If it turns out that it is impossible to remove the tumor surgically, then it is irradiated, and chemotherapy is also prescribed, especially if there are metastases. Radiation and chemotherapy are called “conservative treatments”, i.e. without surgery. As a result of their use, the size and activity of the tumor are reduced, due to which the condition of patients improves.

What pressure pills are prescribed for pheochromocytoma:

• alpha-blockers (prazosin, doxazosin, etc.);
• phentolamine - intravenously, if necessary;
• labetalol, carvedilol - combined alpha and beta blockers;
• calcium antagonists;
• drugs of central action - clonidine (clophelin), imidazoline receptor agonists;
• methyltyrosine is a dopamine synthesis blocker.

The anesthesiologist is advised to avoid fentanyl and droperidol during surgery because these drugs can stimulate additional production of catecholamines. It is necessary to carefully monitor the function of the patient's cardiovascular system at all stages of surgical treatment: during anesthesia, then during the operation and the first day after it. Because severe arrhythmias, a strong decrease in pressure, or vice versa, hypertensive crises are possible. In order for the volume of circulating blood to remain sufficient, it is necessary that the patient receives enough fluid.

2 weeks after the operation, it is recommended to pass a urine test for catecholamines. Sometimes, over time, there are recurrences of the tumor or additional pheochromocytomas are found, in addition to the one that was removed. In such cases, repeated surgical operations are recommended.

Primary hyperaldosteronism

Recall that aldosterone is a hormone that regulates water and mineral metabolism in the body. It is produced in the adrenal cortex under the influence of renin, an enzyme synthesized by the kidneys. Primary hyperaldosteronism is a tumor in one or both adrenal glands that causes too much aldosterone to be produced. These tumors can be of different types. In either case, excess production of aldosterone leads to a drop in potassium levels in the blood and an increase in blood pressure.

Causes and treatment of primary hyperaldosteronism

What is the renin-angiotensin-aldosterone system

To understand what primary hyperaldosteronism is, you need to understand how renin and aldosterone are related. Renin is an enzyme that the kidneys produce when they feel their blood flow is declining. Under the influence of renin, the substance angiotensin-I is converted to angiotensin-II and the production of aldosterone in the adrenal glands is also stimulated. Angiotensin-II has a powerful vasoconstrictive effect, and aldosterone increases sodium and water retention in the body. Thus, blood pressure rises rapidly simultaneously through several different mechanisms. At the same time, aldosterone suppresses the further production of renin so that the pressure does not go off scale. The more aldosterone in the blood, the less renin, and vice versa.

All this is called the renin-angiotensin-aldosterone system. It is a feedback system. We mention that some drugs block its action so that blood pressure does not rise. ACE inhibitors interfere with the conversion of angiotensin-I to angiotensin-II. Blockers angiotensin-II receptors prevent this substance from exerting its vasoconstrictor effect. And there is the most new drug- direct renin inhibitor Aliskiren (Rasilez). It blocks the activity of renin, that is, it acts on more early stage than the drugs we mentioned above. All this is not directly related to the endocrinological causes of hypertension, but it is useful for patients to know the mechanisms of action of drugs.

So, aldosterone in the adrenal glands is produced under the influence of renin. Secondary hyperaldosteronism is when there is too much aldosterone in the blood due to the fact that renin is in excess. Primary hyperaldosteronism - if the increased production of aldosterone by the adrenal glands does not depend on other causes, and the activity of renin in the blood plasma is definitely not increased, rather even reduced. For a correct diagnosis, it is important for a doctor to be able to distinguish between primary and secondary hyperaldosteronism. This can be done based on the results of the tests and tests, which we will discuss below.

Renin production by the kidneys is inhibited by the following factors:

• elevated aldosterone levels;
• excess volume of circulating blood;
• increased blood pressure.

Normally, when a person gets up from a sitting or lying position, renin is produced, which quickly raises blood pressure. If there is an adrenal tumor that produces excess aldosterone, then renin release is blocked. Therefore, orthostatic hypotension is possible - dizziness and even fainting with a sharp change in body position.

We list other possible symptoms of primary hyperaldosteronism:

• High blood pressure, can reach 200/120 mm Hg. Art.;
• Excessive concentration of potassium in the urine;
• Low levels of potassium in the blood, causing patients to experience weakness;
• Elevated sodium levels in the blood;
• Frequent urination, especially the urge to urinate in a horizontal position.

The symptoms that are observed in patients are common to many diseases. This means that it is difficult for a doctor to suspect primary hyperaldosteronism, and it is generally impossible to make a diagnosis without testing. Primary hyperaldosteronism should always be suspected if the patient has severe drug-resistant hypertension. Moreover, if the level of potassium in the blood is normal, then this does not exclude that the production of aldosterone is increased.

The most significant analysis for diagnosis is the determination of the concentration of hormones of the renin-aldosterone system in the blood. In order for the test results to be reliable, the patient must carefully prepare for their delivery. Moreover, preparations begin very early, 14 days in advance. It is advisable at this time to stop taking all the pills for pressure, balance the diet, and beware of stress. For the preparatory period, the patient is better to go to the hospital.

What blood tests do:

• Aldosterone;
• Potassium;
• Plasma renin activity;
• Activity and concentration of renin before and after taking 40 mg of furosemide.

It is advisable to take a blood test for aldosterone early in the morning. At night, the level of aldosterone in the blood should decrease. If the concentration of aldosterone is increased in the morning blood, then this indicates a problem more clearly than if the analysis is taken in the afternoon or evening.

special diagnostic value has a calculation of the ratio of aldosterone content (ng / ml) and plasma renin activity (ng / (ml * h)). The normal value of this ratio is below 20, the diagnostic threshold is above 30, and if more than 50, then the patient almost certainly has primary hyperaldosteronism. The calculation of this ratio has been widely introduced in clinical practice only recently. As a result, it turned out that every tenth patient with hypertension suffers from primary hyperaldosteronism. At the same time, the level of potassium in the blood may be normal and decrease only after a salt load test has been performed for several days.

If the results of the blood tests listed above do not allow an unambiguous diagnosis, then tests are additionally carried out with a load of salt or captopril. Salt load is when the patient eats 6-9 g of table salt per day. This increases the exchange of potassium and sodium in the kidneys and allows you to clarify the results of tests for the content of aldosterone in the blood. If hyperaldosteronism is secondary, then salt loading will slow down the production of aldosterone, and if it is primary, then it will not. The 25 mg captopril test is the same. If the patient has hypertension due to kidney problems or other reasons, then captopril will lower the level of aldosterone in the blood. If the cause of hypertension is primary hyperaldosteronism, then while taking captopril, the level of aldosterone in the blood will remain unchanged.

A tumor in the adrenal glands is trying to determine with the help of ultrasound. But even if ultrasonography shows nothing, it is still impossible to completely exclude the presence of adenoma or adrenal hyperplasia. Because in 20% of cases, the tumor is less than 1 cm in size, and in this case it will not be easy to detect. Computed or magnetic resonance imaging is always desirable to do if primary hyperaldosteronism is suspected. There is also a method for determining the concentration of aldosterone in the blood from the adrenal veins. This method allows you to determine whether there is a problem in one adrenal gland or in both.

Blood pressure in patients with primary hyperaldosteronism can literally go off scale. Therefore, they are especially prone to formidable complications of hypertension: heart attacks, strokes, kidney failure. Also, a low level of potassium in the blood in many of them provokes the development of diabetes.

Treatment

Above, at the beginning of the section on this disease, we provided a table in which we showed that the choice of surgical or drug treatment primary hyperaldosteronism depends on its cause. The physician must correctly diagnose to distinguish unilateral aldosterone-producing adenoma from bilateral adrenal hyperplasia. The latter is considered a milder disease, although it is worse surgical treatment. If the lesion of the adrenal glands is bilateral, then the operation allows to normalize the pressure in less than 20% of patients.

If an operation is planned, then before it, the content of aldosterone in the blood that flows from the adrenal veins should be determined. For example, a tumor of the adrenal gland was found as a result of an ultrasound, computed tomography or magnetic resonance imaging. But according to the results of a blood test, it may turn out that she is not hormonally active. In this case, it is recommended to refrain from the operation. Hormonally inactive tumors of the adrenal cortex are found at any age in 0.5-10% of people. They do not create any problems, and nothing needs to be done with them.

Patients with primary hyperaldosteronism from hypertension are prescribed spironolactone, a specific aldosterone blocker. Potassium-sparing diuretics are also used - amiloride, triamterene. Spironolactone is started immediately with high doses, 200-400 mg per day. If it is possible to stabilize blood pressure and normalize the level of potassium in the blood, then the doses of this drug can be significantly reduced. If the level of potassium in the blood is stably normal, then thiazide diuretic drugs are also prescribed in small doses.

If blood pressure control remains poor, then the drugs listed above are supplemented with long-acting dihydropyridine calcium antagonists. These drugs are nifedipine or amlodipine. Many practitioners believe that ACE inhibitors help well with bilateral adrenal hyperplasia. If the patient has side effects or intolerance to spironolator, eplerenone, a relatively new drug, should be considered.

Itsenko-Cushing syndrome

First, let's introduce the terminology:

• Cortisol is one of the hormones produced by the adrenal glands.
• The pituitary gland is a gland in the brain that produces hormones that affect growth, metabolism, and reproductive function.
• Adrenocorticotropic hormone (adrenocorticotropin) - produced in the pituitary gland, controls the synthesis of cortisol.
• The hypothalamus is one of the parts of the brain. Stimulates or inhibits the production of hormones by the pituitary gland and thus controls the human endocrine system.
• Corticotropin-releasing hormone, also known as corticorelin, corticoliberin, is produced in the hypothalamus, acts on the anterior pituitary gland and causes the secretion of adrenocorticotropic hormone there.
• Ectopic - one that is located in an unusual place. Excess production of cortisone is often stimulated by tumors that produce adrenocorticotropic hormone. If such a tumor is called ectopic, it means that it is not located in the pituitary gland, but somewhere else, for example, in the lungs or in the thymus gland.

Itsenko-Cushing syndrome, also known as hypercortisolism, is a disease in which too much of the hormone cortisol is produced. Hypertension occurs in approximately 80% of patients with this hormonal disorder. Moreover, blood pressure is usually significantly increased, from 200/120 mm Hg. Art., and it can not be normalized by any traditional medicines.

The synthesis of cortisol in the human body is controlled by a complex chain of reactions:

1. First, corticotropin-releasing hormone is produced in the hypothalamus.
2. It acts on the pituitary gland to produce adrenocorticotropic hormone.
3. Adrenocorticotropic hormone signals the adrenal glands to produce cortisol.

Itsenko-Cushing's syndrome can be caused by the following reasons:

• Due to problems with the pituitary gland, too much adrenocorticotropic hormone circulates in the blood, which stimulates the adrenal glands.
• A tumor develops in one of the adrenal glands, while the values ​​of adrenocorticotropic hormone in the blood are normal.
• An ectopic tumor that is not located in the pituitary gland and produces adrenocorticotropic hormone.
• There are also rare causes, which are listed in the table below along with the main ones.

In approximately 65-80% of patients, excess cortisol production occurs due to increased secretion of adrenocorticotropic hormone. In this case, there is a secondary increase (hyperplasia) of the adrenal glands. It's called Cushing's disease. In almost 20% of cases, the primary cause is an adrenal tumor, and this is not called a disease, but Cushing's syndrome. More often there is a unilateral tumor of the adrenal glands - an adenoma or a carcinoma. Bilateral tumors of the adrenal glands are rare and are called micronodular or macronodular hyperplasia. Cases of bilateral adenoma have also been described.

Classification of the causes of hypercortisolism

Type of disease	Detection frequency, 5
Spontaneous hypercortisolism
Cushing's disease (pituitary hypercortisolism)
Ectopic production of adrenocorticotropic hormone
Ectopic production of corticotropin-releasing hormone	Rarely
Cushing's syndrome (adrenal hypercortisolism)
Adrenal carcinoma
Hyperplasia of the adrenal glands
Hereditary forms (syndromes of Carney, McClury-Albright)
Iatrogenic hypercortisolism
Taking adrenocorticotropic hormone
Taking glucocorticoids	Most often
Pseudo Cushing syndrome (alcohol, depression, HIV infection)

Itsenko-Cushing's syndrome is more often observed in women, usually aged 20-40 years. In 75-80% of patients, it is difficult to locate the tumor, even with the use of modern methods computer and magnetic resonance imaging. However, the initial diagnosis of the disease is not difficult, because chronic elevated levels of cortisol in the blood cause typical changes in the appearance of patients. This is called Cushingoid obesity. Patients have a moon-like face, purplish-blue color of the cheeks, fat deposits in the neck, trunk, shoulders, abdomen and hips. At the same time, the limbs remain thin.

Additional symptoms of high cortisol levels in the blood include:

• Osteoporosis and brittle bones.
• Low concentration of potassium in the blood.
• Tendency to form bruises.
• Patients lose muscle mass, look weak, stoop.
• Apathy, drowsiness, loss of intelligence.
• The psycho-emotional state often changes from irritability to deep depression.
• Stretch marks on the abdomen, purple, 15-20 cm long.

Symptoms of elevated levels of adrenocorticotropic hormone in the blood and pituitary tumors:

• Headaches caused by a pituitary tumor that presses from within.
• Body skin pigmentation.
• Women have disorders menstrual cycle, atrophy of the mammary glands, growth of unwanted hair.
• In men - potency disorders, testicular hypotrophy, beard growth decreases.

Diagnostics

First of all, they try to determine the elevated level of cortisol in the blood or daily urine. At the same time, a one-time negative test result does not prove the absence of the disease, because the level of this hormone varies physiologically over a wide range. In urine, it is recommended to determine the indicators of free cortisol, and not 17-keto- and 17-hydroxyketosteroids. It is necessary to measure at least two consecutive daily urine samples.

Sometimes it can be difficult to distinguish Itsenko-Cushing's syndrome from the usual obesity that often accompanies hypertension. To make a correct diagnosis, the patient is given the drug dexamethasone at a dose of 1 mg at night. If there is no Cushing's syndrome, then the level of cortisol in the blood will decrease the next morning, and if it is, then the level of cortisol in the blood will remain high. If the test with 1 mg of dexamethasone previously showed Cushing's syndrome, then another test is performed using a larger dose of the drug.

The next step is to measure the level of adrenocorticotropic hormone in the blood. If it turns out to be high, a pituitary tumor is suspected, and if it is low, then perhaps an adrenal tumor is the primary cause. It happens that adrenocorticotropic hormone produces a tumor not in the pituitary gland, but located somewhere else in the body. Such tumors are called ectopic. If the patient is given a dose of 2-8 mg of dexamethasone, then the production of adrenocorticotropic hormone in the pituitary gland is suppressed, even despite the tumor. But if the tumor is ectopic, then high-dose dexamethasone will not affect its activity in any way, which will be seen from the results of a blood test.

To establish the cause of the disease - a pituitary tumor or an ectopic tumor - corticotropin-releasing hormone can also be used instead of dexamethasone. It is administered at a dosage of 100 mcg. In Cushing's disease, this will lead to inhibition of the content of adrenocorticotropic hormone and cortisol in the blood. And if the tumor is ectopic, then hormone levels will not change.

Tumors that cause increased production of cortisol are looked for using computed tomography and magnetic resonance imaging. If microadenomas with a diameter of 2 mm or more are found in the pituitary gland, then this is considered irrefutable evidence of the presence of Cushing's disease. If the tumor is ectopic, then it is recommended to carefully, step by step, "enlighten" the chest and abdominal cavity. Unfortunately, ectopic tumors can be very small and produce high doses of hormones. For such cases, magnetic resonance imaging is considered the most sensitive examination method.

Treatment

The cause of Itsenko-Cushing's syndrome is a tumor that produces an "extra" hormone cortisol. Such a tumor may be located in the pituitary gland, adrenal glands, or somewhere else. The real way of treatment, which gives a lasting effect, is the surgical removal of the problematic tumor, wherever it is. Methods of neurosurgery for the removal of pituitary tumors in the XXI century have received significant development. In the world's best clinics, the rate of complete recovery after such operations is more than 80%. If the pituitary tumor cannot be removed in any way, then it is irradiated.

Varieties of Itsenko-Cushing's syndrome

Within six months after the removal of the pituitary tumor, the patient's cortisol level is too low, so they are prescribed replacement therapy. However, over time, the adrenal glands adapt and begin to function normally. If the pituitary gland cannot be cured, then both adrenal glands are surgically removed. However, after this, the production of adrenocorticotropic hormone by the pituitary gland still increases. As a result, the patient's skin color may darken significantly within 1-2 years. It's called Nelson's syndrome. If adrenocorticotropic hormone is produced by an ectopic tumor, then with a high probability it will be malignant. In this case, chemotherapy is needed.

With hypercortisolism, the following drugs can theoretically be used:

• affecting the production of adrenocorticotropic hormone - cyproheptadine, bromocriptine, somatostatin;
• inhibiting the production of glucocorticoids - ketoconazole, mitotane, aminoglutethimide, metyrapone;
• blocking glucocorticoid receptors - mifepristone.

However, doctors know that these drugs are of little use, and the main hope is for surgical treatment.

Blood pressure in Itsenko-Cushing's syndrome is controlled with spironolactone, potassium-sparing diuretics, ACE inhibitors, selective beta-blockers. They try to avoid drugs that negatively affect metabolism and reduce the level of electrolytes in the blood. Medical therapy hypertension in this case is only a temporary measure before radical surgery.

Acromegaly

Acromegaly is a disease caused by excessive production of growth hormone. This hormone is also called growth hormone, somatotropin, somatropin. The cause of the disease is almost always a tumor (adenoma) of the pituitary gland. If acromegaly begins before the end of the growth period at a young age, then such people grow up to be giants. If it starts later, then the following clinical signs appear:

• coarsening of facial features, including massive lower jaw, developed brow ridges, prominent nose and ears;
• disproportionately enlarged hands and feet;
• There is also excessive sweating.

These signs are very characteristic, so any doctor can easily make a primary diagnosis. To determine the final diagnosis, you need to take blood tests for growth hormone, as well as for insulin-like growth factor. The content of growth hormone in the blood in healthy people never exceeds 10 μg / l, and in patients with acromegaly it exceeds. Moreover, it does not decrease even after taking 100 g of glucose. This is called a glucose suppression test.

Hypertension occurs in 25-50% of patients with acromegaly. Its cause is believed to be the property of growth hormone to retain sodium in the body. There is no direct relationship between blood pressure indicators and the level of somatotropin in the blood. In patients with acromegaly, significant hypertrophy of the myocardium of the left ventricle of the heart is often observed. It is explained not so much by the increased blood pressure how many changes in the hormonal background. Because of it, the level of cardiovascular complications among patients is extremely high. Mortality - about 100% within 15 years.

For acromegaly, the usual, conventional first-line blood pressure medications are given, either alone or in combination. Efforts are directed to the treatment of the underlying disease by surgical removal pituitary tumors. After surgery, blood pressure in most patients decreases or completely normalizes. At the same time, the content of growth hormone in the blood is reduced by 50-90%. The risk of death from all causes is also reduced several times.

There is evidence from studies that the use of bromocriptine can normalize the level of growth hormone in the blood in about 20% of patients with acromegaly. Also, short-term administration of octreotide, an analogue of somatostatin, suppresses the secretion of somatotropin. All of these activities can lower blood pressure, but the real long-term treatment is surgery or X-rays of the pituitary tumor.

hyperparathyroidism

Parathyroid glands (parathyroid glands, parathyroid glands) are four small glands located on the posterior surface of the thyroid gland, in pairs at its upper and lower poles. They produce parathyroid hormone (parathormone). This hormone inhibits the formation of bone tissue, leaches calcium from the bones, and increases its concentration in the blood and urine. Hyperparathyroidism is a disease that occurs when too much parathyroid hormone is produced. The most common cause of the disease is hyperplasia (overgrowth) or tumor of the parathyroid gland.

Hyperparathyroidism causes bones to bone is replaced by a connecting one, and in urinary tract calcium stones are formed. The doctor should suspect this disease if the patient has hypertension combined with high blood calcium levels. In general, arterial hypertension is observed in approximately 70% of patients with primary hyperparathyroidism. And by itself, parathyroid hormone does not increase blood pressure. Hypertension occurs due to the fact that with a long course of the disease, the function of the kidneys is impaired, the vessels lose the ability to relax. Parathyroid hypertensive factor is also produced - an additional hormone that activates the renin-angiotensin-aldosterone system and increases blood pressure.

Based on the symptoms, without tests, it is impossible to immediately make a diagnosis. Manifestations from the bones - pain, fractures. From the side of the kidneys urolithiasis disease, kidney failure, secondary pyelonephritis. Depending on which symptoms prevail, two forms of hyperparathyroidism are distinguished - renal and bone. Tests show an increased content of calcium and phosphates in the urine, an excess of potassium and a lack of electrolytes in the blood. X-rays show signs of osteoporosis.
Blood pressure rises by initial stages hyperparathyroidism, and lesions of target organs develop especially rapidly. Normal performance parathyroid hormone in the blood - 10-70 pg / ml, and with age upper bound increases. The diagnosis of hyperparathyroidism is considered confirmed if there is too much calcium in the blood and at the same time an excess of parathyroid hormone. They also conduct ultrasound and tomography of the parathyroid gland, and if necessary, then a radiological contrast study.

Surgical treatment of hyperparathyroidism is recognized as safe and effective. After surgery, more than 90% of patients recover completely, blood pressure normalizes according to various sources in 20-100% of patients. Pressure tablets for hyperparathyroidism are prescribed, as usual, first-line drugs alone or in combinations.

Hypertension and thyroid hormones

Hyperthyroidism is an increased production of thyroid hormones, and hypothyroidism is their deficiency. Both problems can cause drug-resistant hypertension. However, if the underlying disease is treated, then blood pressure will return to normal.

A huge number of people have problems with the thyroid gland, especially often in women over 40 years old. The main problem is that people with this problem do not want to go to an endocrinologist and take pills. If thyroid disease remains untreated, then life is greatly reduced and its quality worsens.

Main symptoms of an overactive thyroid gland:

• thinness, despite a good appetite and nutritious food;
• emotional instability, anxiety;
• sweating, heat intolerance;
• palpitations (tachycardia);
• symptoms of chronic heart failure;
• skin is warm and moist;
• the hair is thin and silky, early gray hair is possible;
• the upper arterial pressure is more likely to be increased, and the lower one may be lowered.

Main symptoms of a lack of thyroid hormones:

• obesity resistant to attempts to lose weight;
• chilliness, cold intolerance;
• puffy face;
• swelling;
• drowsiness, lethargy, memory loss;
• hair is dull, brittle, falls out, grows slowly;
• the skin is dry, the nails are thin, exfoliate.

You need to take blood tests:

• Thyroid-stimulating hormone. If the function of the thyroid gland is reduced, then the content of this hormone in the blood is increased. Conversely, if the concentration of this hormone is below normal, it means that the thyroid gland is too active.
• T3 is free and T4 is free. If the indicators of these hormones are not normal, then the thyroid gland needs to be treated, even despite the good numbers of thyroid-stimulating hormone. There are often disguised thyroid problems in which thyroid-stimulating hormone levels are normal. Such cases can only be detected by testing for free T3 and free T4.

Endocrine and cardiovascular changes in thyroid diseases

If the thyroid gland is too active, then hypertension occurs in 30% of patients, and if the body is deficient in its hormones, then the pressure is increased in 30-50% of such patients. Let's take a closer look.

Hyperthyroidism

Hyperthyroidism and thyrotoxicosis are the same disease, an increased production of thyroid hormones that speed up metabolism. Increased cardiac output, heart rate and myocardial contractility. The volume of circulating blood increases, and peripheral vascular resistance decreases. The upper arterial pressure is more likely to be increased, and the lower one may be lowered. This is called systolic hypertension, or elevated pulse pressure.

Let your endocrinologist prescribe the therapy for hyperthyroidism. This is a broad topic that goes beyond the scope of a site about treating hypertension. As pressure pills, beta-blockers are considered the most effective, both selective and non-selective. Some studies have shown that non-selective beta-blockers can reduce excess synthesis of T3 and T4 thyroid hormones. It is also possible to prescribe non-dihydropyridine calcium antagonists, which slow down the pulse rate. If hypertrophy of the left ventricle of the heart is expressed, then ACE inhibitors or angiotensin-II receptor blockers are prescribed. Diuretic drugs complement the effects of all these drugs. It is undesirable to use dihydropyridine calcium channel blockers and alpha-blockers.

Hypothyroidism - reduced production of thyroid hormones or problems with their availability to body tissues. This disease is also called myxedema. In such patients, cardiac output is reduced, the pulse is reduced, the volume of circulating blood is also reduced, but at the same time, peripheral vascular resistance is increased. Blood pressure rises in 30-50% of patients with hypothyroidism due to increased vascular resistance.

Analyzes show that in those patients who developed hypertension on the background of hypothyroidism, the level of adrenaline and norepinephrine in the blood is increased. Elevated diastolic “lower” blood pressure is characteristic. Upper pressure may not rise because the heart is working sluggishly. It is believed that the more elevated the lower pressure, the more severe the hypothyroidism, i.e., the more acute the lack of thyroid hormones.

Treatment of hypothyroidism - pills that an endocrinologist will prescribe. When the therapy begins to act, the state of health improves and the pressure in most cases normalizes. Take repeated blood tests for thyroid hormones every 3 months to adjust the doses of the pills. In elderly patients, as well as those with a long “experience” of hypertension, treatment is less effective. These categories of patients need to take blood pressure pills along with medications for hypothyroidism. ACE inhibitors, dihydropyridine calcium antagonists, or alpha-blockers are usually prescribed. You can also add diuretics to enhance the effect.

conclusions

We looked at the main endocrine causes, other than diabetes, which cause a strong increase in blood pressure. It is characteristic that in such cases traditional methods of treating hypertension do not help. It is possible to stably bring the pressure back to normal only after taking control of the underlying disease. In recent years, doctors have made progress in solving this problem. Particularly pleased with the development of the laparoscopic approach in surgical operations. As a result, the risk for patients has decreased, and recovery after surgery has accelerated by about 2 times.

If you have hypertension + type 1 or type 2 diabetes, then study.

If a person has hypertension due to endocrine causes, then usually the condition is so bad that no one pulls to see a doctor. An exception is problems with the thyroid gland - a deficiency or excess of its hormones. Tens of millions of Russian-speaking people suffer from thyroid diseases, but are lazy or stubbornly unwilling to be treated. They are doing themselves a disservice: shortening their own lives, suffering from severe symptoms, risking a sudden heart attack or stroke. If you have symptoms of hyper- or hypothyroidism - take blood tests and go to an endocrinologist. Do not be afraid to take thyroid hormone replacement pills, they provide significant benefits.

The most rare endocrine causes of hypertension remained outside the scope of the article:

• hereditary diseases;
• primary hyperrenism;
• endothelin-producing tumors.

The probability of these diseases is much lower than that of a lightning strike. If you have any questions, please ask them in the comments to the article.

1. Galina

   Thanks a lot for the article!
   I will hand over analyzes on hormones and I will try to treat hypertension correctly.

2. Ella Stepina

   Good day! I am 38 years old, height 158 ​​cm, weight 40 kg, chronic diseases I have none, except for hemorrhoids (3 years) and migraine, the duration of which is 10 years, but its intensity is decreasing. More often the head and neck area hurts, the work is motionless. Recently, there has been a steady increase in diastolic pressure against the background of a slight increase in systolic. Difference 20-25 mm, lower about 90 and above, rarely 130/100 (105). In the morning, the pressure is 90/70, then it rises. I used to be hypotonic, with age the pressure became a little higher, but if the upper one rose to 120, then I felt bad, nausea was present. Now the increase in diastolic pressure did not feel in any way, it just turned out during the measurement. Papazol 1 tablet reduces it to 75. I took thyroid hormones for a long time - within the normal range. Cholesterol is also elevated - 6.3. Rest biochemical analyzes blood and urine are normal. 3 months ago I handed them over in the hospital during hospitalization with migraine status. Nervousness, anxiety, intermittent bowel pain and constipation and, possibly against the background of pressure control, pain in the heart are noted. I have always been slim, the food is very moderate and proper, except for the consumption of salt (I like pickles). I do not carry out drug therapy, including hormonal ones, I only take NVPS for migraine attacks. Could you tell me, please, what is the increase in diastolic pressure in the first place? Where to start the survey? Thanks!

3. flora(tsvetok)

   I am 73 years old, height 1-58, weight 76 kg. I am a hypertensive with experience - since 50 years! But everything went smoothly. She took kristepin, then Enap. Everything was stable 135/70. Sometimes there were also high numbers of 150-160 to 70-80. But in the last couple of years, it has become more common to rise 160-170 to 80! Saw Valz helped for half a year, then the numbers became high! Changed to Nebilet, but to no avail! For 3 weeks now, the pressure has gone off the chain! Constantly rises to 180-200 at 60-70. The top is very high! There are no headaches (very rarely), but the head is heavy at the same time! I notice that sometimes I am pulled to the side. The doctor prescribed Niperten in the morning (sometimes heart problems), in the evening - Physiotens. If during the day it rises - indapamide or Fozikard. And if at 22 o'clock it rises, before going to bed, then physiotension. But from pill to pill, the pressure rises to 200. I don’t know what the reason is. Sometimes pills don't work. How to be?

4. Ludmila

   Good day! I am 62 years old. Height 173. Weight 78 kg. I don’t even know where to start ... I drink Magnelis B6 for 9 pcs, drank 2 packs and another pack of magnerot 50 pcs, now I started Magne-B6 French, 50 tabs, I already drank half. I eat fish oil, pharmacy lecithin, I drink dibicor on an empty stomach, I have been eating according to the Malakhova system for 2 years, I lost 24 kg. Almost all diseases are gone, but the pressure does not go away. There is also mild angina and ischemia. I drink lisinoton and nebilet every day, I don’t remember how many years. I used to take other pills. I used to have metabolic syndrome, but it's been gone for a year now. Now according to the analyzes: Ultrasound of the liver diagnosed hepatomegaly, diffuse changes liver, kidney and pancreas, chronic cholecystitis. Duplex scanning of the brain showed atherosclerosis of the brachiocephalic arteries. Ultrasound of the thyroid gland found one nodule, and before there were three. I had my hormones tested and they are normal. I haven't been to an endocrinologist yet, I'm going to. ALT 20.9, AST 28.2, but the norm is up to 31. No protein was found in the urine, the analysis is good. The clinic and blood biochemistry are normal. Nevertheless, almost the third week of treatment according to your method ends and there is no result. I try to remove carbohydrates, but it does not work at all. I just take it with a low glycemic index. I eat four times a day. In the morning 200 g of raw beet and carrot salad, celery stalks with 1 tbsp. l. linseed oil and 2 eggs. At lunch, 120 g of breast or a breast cutlet with beef and salad 250 g before meals. An afternoon snack of 10 almonds and 200 grams of low glycemic fruit - an apple or a pear. Sometimes I add salad. Dinner - salad and salmon or other fish. All three salads linseed oil. In the morning I steam 2 tsp. flax seed. I don’t eat salt, instead I take dry pharmacy kelp. This is what nutrition is. I drink 1.5-2 liters of water a day. Help me cope with hypertension. Thanks!

   1. admin Post author

      >ends almost 3rd week
      > treatment according to your method
      > and no result

      You do not indicate what your blood pressure readings were and are.

      Eating fruits, beets, and carrots that are off limits on a low-carbohydrate diet causes your insulin levels to spike. It constricts blood vessels and retains fluid in the body. Perhaps the pressure is increased because of this. I advise you to study the book "Atkins' New Revolutionary Diet" and stick to the diet.

      Also, your vessels are significantly affected by atherosclerosis. In such a situation, reducing the pressure to 120/80 may not be possible at all. If you achieve 140/90, it will already be good.

      > used to have metabolic syndrome,
      > but it's been a year since he's been gone

      How did you know this? Did the fortuneteller whisper or according to the results of the analyzes?

      > start magne-v6 french

      You will go broke on it :). Order supplements from the USA as I recommend to save 4-6 times.

      > Just take low glycemic index.

      The glycemic index is nonsense, charlatanism. Just do not eat any fruits and forbidden vegetables. Suitable sources of fiber are green vegetables and flax seeds. Fruits do you more harm than good.

      1. Ludmila

         Good evening! Thanks for the answer. You didn't reassure me. But I will still continue to drink magnesium, taurine, omega-3, lecithin, vitamins and try to find out the cause of hypertension. Why did I write about the metabolic syndrome in this way - I understand that it is:
         1. Excess visceral fat (just determined by waist circumference)
         2. High blood pressure (more than 135/90 at rest)
         3. High cholesterol and/or triglycerides with low HDL (low "good" cholesterol)
         4. Elevated blood glucose - well, here I will not even explain.

         Any 2 conditions in addition to the 1st (i.e., in addition to obesity) are considered to be metabolic syndrome. So, two years ago my weight was 102 kg, now 78 and everything is in order with the waist, cholesterol has long been normal. I haven't eaten sweets in two years, except for fruits with a low glycemic index. I also excluded flour, potatoes, sugar, vinegar, trans fats, canned food, convenience foods, gastronomy, pickled vegetables, caffeine, alcohol, and more. My pancreas is calm, sugar is normal, the diet is three times a day, insulin is thrown into the blood three times, there are no problems with the gastrointestinal tract. Of the entire list, only pressure increases. Therefore, I concluded that the metabolic syndrome is no longer there. Sclerosis - yes, it is noticeable. But magnesium, lecithin and healthy eating it will cleanse the vessels, I hope it only takes time ... I drank higher doses of magnesium, I switch to 350 mg per day. I really want to prescribe Natural Calm magnesium citrate, but so far I haven’t been able to, I’m not good at computers. last week I tried to remove fruits, cereals, bread, all carbohydrates. The body is on strike, there is a craving for sweets, I will try to buy and drink chromium picolinate. Reading the Atkins diet.
         As for my pressure, it does not rise above 140/90, but this is rare, I take pills every day. There used to be hypotension with a pressure of 90/60, and now a crisis and vomiting with indications of 120/80. Just before I got to know your site and started drinking magnesium, I was being taken away from work in an ambulance and given an injection of magnesia. There were no more crises and I noticed that Capotena began to drink less in addition to lysinoton and non-bilet. This is already pleasing. I measure the pressure with a nissei wrist machine, my norm is 100-110/70.

      2. Inna

         Hello. I am 55 years old, height 159 cm, weight 58 kg. For a year and a half I drank lisinopril in the morning, then and in the evening. It became bad: the head hurts, the buzz in the head, presses on the ears. The doctor prescribed perindopril and indapamide instead. From them for a week I almost went crazy: my head hurts, hum, ears and even tingling of the whole body. The doctor has already prescribed losartan in the morning, but there is a tingling sensation from it and my heart aches. I drink for two days. According to your system, I also drink omega-3 and magnesium-B6 for two days. Taurine has not yet bought. The analyzes are as follows: cholesterol 8.3 and uric acid 383, urine is normal, I will still give hormones. Tell me what I have and what else to do? One doctor says that it is from the vessels of the head, the other - from the cervical vertebra, which pinches, and the third one does not know. Charging according to Mesnik N.G. do. Thank you.

         Denis

         Hello! Mother 77 years old, 160 cm, 65 kg. Hypertension has been pestering her for about 20 years - from the moment when, on suspicion of cancer, the thyroid gland was almost completely removed. As it turned out later, in vain - on the ultrasound they saw only large knots and hurried. Now my mother suffers from hypertension. The pressure sometimes reached 240/110, working 150/90. Of the drugs, only clonidine, sometimes captopril, helps to reliably fight crises. In autumn and winter, the pressure reaches 200/90 almost daily. I have to take clonidine two or three times a week.
         According to the results of analyzes and studies:
         Cardiologist: hypertonic disease 3 st, risk 4
         Endocrinologist: type 2 diabetes.
         Orthopedist: osteochondrosis of the spine, arthrosis.
         Daily medication intake:
         Glibomet, Coformin, L-thyroxine, Bisoprolol (?), Fosinopril, Arifon retard, Nifedipine, Noliprel.
         + captopril, rarely clonidine.
         On the recommendation of a doctor, she underwent a course of injections of papaverine with dibazol (20 times) + magnesium intravenously (10 times).
         Now, after 4 months since the beginning of autumn, the pressure has become a little better, maybe due to medication or somehow “from the weather”.
         The question is how to get away from at least some of these drugs, replacing them with either exercises or procedures?
         We live in a resort. There are also radon / hydrogen sulfide baths nearby, physiotherapy.
         We cannot find a doctor who is capable of an integrated approach both from the side of cardiology and from the side of endocrinology ... And perhaps from the side of orthopedics? ..
         Thanks!

      3. Dubrovskaya

         Hello. I am 30. Height 166 cm, weight 70 kg. Diseases - osteochondrosis, small hernia, heart failure of the 1st degree mitral valve, bilateral chronic pyelonephritis, there are small stones in the kidneys, arrhythmia, tachycardia. I sweat a lot, lack of coordination. Recently, the pressure began to rise, for about a month and a half, mostly 180/110. Cortisol levels are elevated. Is there a suspicion of an adrenal tumor?

      4. Irina

         Hello! I am 42 years old, height 175 cm, weight 82 kg. I have a problem that has been bothering me for 4 years now. Rapid rises in blood pressure, with trembling, fear, dizziness and tachycardia. Sometimes pain in the chest. Before lifting, I feel increased sensitivity in the hands and the back of the head, as in high temperature. The pressure rises to 150-160/90-100. Now rises generally in the evening, can and at night. If I can’t fall asleep or wake up abruptly, such an attack begins. There is a fear of falling on the street or even dying. I turned to a cardiologist (ultrasound of the heart, ECG, Holter monitoring) - everything was within the normal range. Endocrinologist - thyroid hormones, ultrasound of the adrenal glands - the norm. Therapist - a general blood test, biochemistry, sugar - the norm. Ultrasound of the abdominal cavity and kidneys - without deviations. I even consulted with a neurologist - without deviations. The psychotherapist diagnosed an anxiety disorder with panic attacks. She took Amitriptyline + alprazolam according to the scheme for 6 months - attacks of pressure rise with trembling were less common, but did not stop. More from medicines periodically prescribed Phenibut, Glycine, Lorafen, afobazole, Grandaxin and other tablets. From hypertension and palpitations - Anaprilil, metoprolol, bisoprolol. During the attack itself, I take Kapoten under the tongue or Metoprolol. Already tired. I want to find a drug that will not allow the pressure to rise. Give advice if possible.

      5. Vladimir

         Hello. Can I start the Atkins diet and take supplements with high levels of uric acid in the blood?

      6. Natalia

         Good day! My son is 19 years old, height 185 cm, weight 85 kg. Two years ago, when passing a medical commission at the military registration and enlistment office, it turned out that he had high blood pressure. They passed the examination, including ABPM, showed an average pressure of 145/80. They passed all the necessary tests, did an ultrasound of the kidneys, adrenal glands, thyroid gland. They underwent MRI from the vessels of the brain to the kidneys. In general, everything that was prescribed and read by myself. All surveys did not reveal any obvious violations, at least something that could affect the pressure. A diagnosis of essential hypertension was made. During these two years, they drank a whole bunch of drugs. One was assigned, then another. There is no result. The son said that he didn’t want to “poison” his body anymore, and stopped taking the pills. As a result of not taking the pills, or because of the duration of the disease, his average blood pressure is now 150/80. There are jumps in the upper pressure up to 170. He does not particularly complain about his condition. Says he feels good. Although outwardly, his pressure jumps are easily noticeable to me. The collar zone and his face are red. At such moments, I measure his pressure - as a rule, 160-170 upper. Advise what to do? The only thing he did not do was not take hormone tests (I plan to send him in the coming days). Our city is small, you can say there are no doctors. The guy is young, maybe you can do without lifelong drug therapy. P.S. My son leads a healthy lifestyle, studies at a military university, there is food, physical education, and sports training. In general, there are no complaints from this side. Thanks in advance for your reply.

      7. Natalia

         Many thanks for the article. I am 53 years old, height 167 cm, weight 75 kg. I have hypertension, I think, against the background of hypothyroidism (TSH is normal) and depression. I have been taking antidepressants for 9 months. The pressure is not always high. Now mostly in the morning 110-120 / 60-70, and in the evening it can be 150-170 / 80-90, severe headaches, anxiety and anxiety at the same time. I take 1/4 tablet of bisoprolol and lozap. I took tests several times during the year, while in the hospital (3 times) - all indicators are normal, except for leukocytes. Ultrasound of the thyroid gland showed the presence of two nodes (in 2006 there were 7) and hypofunction.

      8. Inna

         Good day!
         I am 37 years old, height 180 cm, weight 105 kg. At the same time, it is difficult to call me very fat - even in my youth, playing sports and having practically no fat, I weighed at least 80 kg. "Wide bone" - apparently, about me)) Wedding ring size 20 ...
         In 2006, they discovered a large nodule in the thyroid gland, I was pregnant. After the end of the GV, she again turned to the endocrinologist - the node increased significantly and it was recommended to remove it. In 2008, the entire lobe and isthmus were removed, suspecting an adenoma. The histological results revealed a carcinoma. She was registered with an oncology dispensary and prescribed levothyroxine at a lethal dose so that TSH was minimal. Of course, I could not live with hypothyroidism for a long time, I switched to 100 mg, then to 75. In principle, I felt fine. But last year there were panic attacks, palpitations, fog in the head. The pressure reached 180/140. The heart is normal, hormones are normal as usual, bad cholesterol is normal, sugar is a little high, but also within the normal range. On the kidney small cyst 1 cm. But in the remainder of the thyroid gland there are 3 nodes, one 1.5 cm and cysts. Cardiologists prescribed a lot of drugs - Enap saw, metoprolol, carvedilol, now Concor. The pressure is within 140/100, and the lower one is never less than 90, even if the upper one is 120. The endocrinologist does not see the causes of hypertension in the thyroid gland. I have been drinking Omega 3 + Coenzyme Q10 + Magnesium with iHerb for 3 months, but there are no special results. Without pills, the pressure rises again. Tell me where else to look for reasons?

      9. Oksana

         Good day! Thank you for the article. I am 37 years old, no children yet. Height 169 cm, weight 55 kg. A month ago, there was a hypertensive crisis, the pressure increased to 140/90. I am hypotensive and my normal blood pressure is 100/60. They called an ambulance twice to bring down the pressure. The next day she went to the hospital. Examined internal organs, heart, blood vessels, thyroid gland - everything is in order. A diagnosis of neurocirculatory dystonia was made. A month after discharge, I drink adaptol, vinoxin, corvasan, magne b6, berlipril. A month later, the day before menstruation, there was a sharp jump, Berlipril lowered, after menstruation, the same thing a day later - I had to call an ambulance. The next two days after lunch or late in the evening the pressure increased - I drink Anaprilin and Berlipril. Everything is fine this morning. Can you tell me what hormones it is related to? Thank you.

      10. Ludmila

          I am 60 years old, height 168 cm, weight 86 kg. A year ago, autoimmune thyroiditis was diagnosed - I take L-thyroxine. Also bronchial asthma, which is now stabilized, only occasionally have to use Berotek. Still urolithiasis, problems with joints, well, and little things - glaucoma with normal eye pressure, prediabetes. During pregnancy, there was high sugar, and now it is at the limit - it can be up to 6.0. My biggest concerns are swelling in my ankles, joint pain, and the inability to correct my weight with nutrition. Increasing pressure noticed by chance itself. Head is spinning. Measured the pressure - 160/90. In the autumn I was at the doctors for examination. There were no problems with the heart. And the pressure was 110/70. It's been low for me all my life. I am now out of town, in the near future it is problematic to get into the city. I am a paramedic by training, I started the treatment myself - Egilok and triampur. I drink 3 days, but the pressure remains 160/90 in the morning and evening. Advise me which medication is best for me?

      11. Irina

          Hello. Thank you for the information posted on the site, and I really hope that the site is still active.
          I am 52 years old, height 169 cm, weight 77 kg. Since childhood, periodic headaches on the right side, the pressure at school was measured - it was normal. Stable since about 35 increased rates BP - 145/90, by the age of 45 - 155-165/95. Headaches mainly on the right, with a frequency of 3-4 times a month. Also meteorological dependence, heaviness in the occipital part of the head, with a transition to the temporal regions. She did not take any pills, except for a very moderate intake of potassium-sparing diuretics (not more than 1-2 times a month), since swelling of the face began to appear in the morning, which could go away by itself during the day. For the last two years, blood pressure indicators have deteriorated significantly - 170/105. Sometimes the right hand goes numb, if you suddenly change the position of the body - a lack of coordination, there is a feeling that I can fall. It rarely appears, for example, in the bathroom when I get up. Swelling of the legs began to appear in the evening and sometimes in the morning. The therapist prescribed Lorista tablets with a diuretic. I drank continuously for about 6 months, but the result is zero. Decided not to get sick anymore. I went for a full check up. MRI and Doppler showed that the circle of Willis is open, there is a significant hypoplasia of the vertebral artery on the right, the left one is compensatory dilated. They prescribed a course of cerebrolysin - almost to no avail. Pierced magnesium. The upper pressure temporarily (for no more than a week) dropped to 135, while the lower pressure did not move at all from 105-107. A diagnosis of vertebrobasilar insufficiency was made. The doctor advised me to carry captopril with me and take it with an upper pressure above 170. About two months after the course of treatment, the pressure reaches the level of 197/110. Heaviness in the back of the head, it can be difficult to find the right word. For the last three days I have been going to a chiropractor, I do not drink pills on purpose, for the purity of the experiment. He put my vertebrae in place, all departments. Vitamin B12 is also injected into the neck area, massage of the cervical-collar zone, jars on the back with punctures, acupuncture. I felt better, the pressure dropped to 155, the lower one remains 105. This worries me. Realizing that the relief will be temporary, I ask for advice - what tests should I go through and which doctor should I contact with my problem?

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