Heart and cardiovascular system

Arterial hypertension, are you aware of the secondary causes?

April 9, 2019

The “secondary hypertensions”, which are different from the “essential” or “without cause” that afflict the majority of the population, are less known and quite rare diseases that can cause problems of different types. Generally linked to the diseases of the surrene and the pituitary gland, these diseases are not always sought, it can take years before they are diagnosed. It is estimated that the hypertension may be the symptom of presentation of at least fifteen endocrine diseases. This is why a multidisciplinary approach is important, particularly between endocrinologists and cardiologists. We talked about it with Dr. Alberto Stefano Tresoldi who, after a period spent in England where he worked on clinical research and outpatient activities in the field of diseases of the surrene and the pituitary gland, began to work as an endocrinologist in Humanitas Medical Care, more precisely in the offices of Rozzano, Arese, Castellanza, Varese and, since January, in the new clinic in Viale Premuda in Milan.


15% of cases of hypertension depend on the hormone diseas

“Until a decade ago it was thought that about 5% of cases with high blood pressure were due to hormonal changes, a fact underestimated according to recent scientific literature, because the latest studies seem that almost 15% of conditions of hypertension is of a secondary nature – explained Dr. Tresoldi -. An important fact is also the age of onset of the problem: about one third of the patients who are diagnosed with a problem of high blood pressure before the age of forty suffer from secondary hypertension”.

This is why, especially in young people, it may be advisable to carry out a full screening to exclude hormonal diseases that, often, are evident even from a simple visit by the specialist. It is estimated that arterial hypertension may be the symptom of presentation of at least fifteen endocrine diseases.


Surreneal diseases that cause high blood pressure

The pituitary gland is a gland located at the base of the skull that regulates the hormonal function of a large part of the body. When not functioning properly it can give a series of clinical pictures, of which high blood pressure is one of the possible. Surreni are the glands located on the posterior pole of each kidney that secrete different hormones that can affect the activity of the entire body.

“The main cause of secondary hypertension is precisely a disease of the surrene called “primitive hyperaldosteronism”, a condition in which the hormone aldosterone that regulates the levels of sodium and potassium within our body is produced in excess – said the specialist -. According to recent studies (including an Italian of 2006), almost 1 in 10 cases of high blood pressure is due to excess aldosterone. In these cases the body retains more sodium and eliminates more potassium at the renal level, causing an increase in blood pressure.

Another less frequent cause of secondary hypertension is pheochromocytoma, which is an adrenal tumor that produces excess adrenaline and norepinephrine, or the rarer causes of high blood pressure that usually occur in adolescence.

As far as the Surreni are concerned, both the excess of cortisol and growth hormone, which two hormones whose regulation depends on the pituitary gland, can cause problems with high blood pressure.

In the case of cortisol, a syndrome called Cushing’s syndrome develops, characterized not only by an increase in blood pressure, but also by other problems such as diabetes, osteoporosis, fractures and alteration of the menstrual cycle in women. Excessive cortisol production can be due to both an adenoma (benign tumour) and, in the worst cases, a carcinoma (malignant tumour) of the surrene; however, in most cases it depends on the pituitary gland itself, which stimulates healthy surreneums to produce cortisol in abundance. The excess of the growth hormone leads to changes in the person’s physiognomy and an increase in the size of the hands and feet; the disease is in fact called “acromegaly”, and can be diagnosed by an endocrinologist expert in pituitary diseases simply by observing the patient.


Diagnosis and treatment

In most cases, blood or urine tests for the suspected disease are required to investigate the presence of these diseases. Therefore, simple routine tests are not sufficient. Only after that may it be necessary to perform an examination that evaluates the appearance of the gland concerned, in order to confirm the presence of the disease.

For the diseases of the surrene, when the disease is localized to only one side, the picture can be solved by “removing the sick surrene that produces in excess the hormones, reaching in some cases even to suspend completely the drug therapy for the pressure. It is an abdominal surgery that is also performed in laparoscopy and provides a short hospitalization, “said the expert. In the case of pituitary diseases, the procedure, which consists of removing the adenoma and leaving the surrounding healthy pituitary gland, is usually performed by means of a nose access. If this is not curative, there are medical therapies that can reduce the secretion of excess hormones.

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