The adrenal glands are small paired glands located at the upper poles of the kidneys. Each organ consists of a medulla and a cortical covering it, which, in turn, is functionally divided into three zones responsible for the production of certain hormones:
1. Glomerular - aldosterone, which affects kidney function
2. Bundle - cortisol, which is responsible for the metabolism
3. Mesh - androgens produced by both men and women.
The brain substance creates and releases adrenaline and norepinephrine, which play a major role in the regulation of blood pressure.
Dysfunction of the adrenal glands leads to a disease called endocrine arterial hypertension.
How does the adrenal glands affect blood pressure?
Aldosterone
The main target of this hormone is the kidneys. It promotes the release of potassium ions, and retains the sodium and chlorine content. Thanks to the action of aldosterone, the ability of cells and tissues to retain water is increased. This is how the water and mineral balance in the body is maintained.
The result of the action of aldosterone is an increase in blood volume in the vascular bed and an increase in blood pressure. Normally, this mechanism is activated with blood loss and hypotension.
Cortisol
It is often referred to as the stress hormone, and this is partly true. This substance circulates in our body constantly, and in the morning its concentration is higher than in the evening.
It regulates blood sugar and its transformation in the liver, the immune system, and also affects blood pressure and the work of the cardiovascular organs in this way:
- Increases the sensitivity of blood vessels to adrenaline;
- Reduces capillary permeability;
- Keeps arterioles in good shape;
- Increases the contractile function of the myocardium;
Adrenalin
Adrenaline affects the body in several ways:
- Increase in cardiac output and blood pressure when the beta-adrenergic receptors of the heart are excited;
- Constriction of peripheral vessels;
- Activation of the receptors of the glomerular apparatus of the kidneys, which activate the hormonal system (renin-angiotensin-aldosterone), which is responsible for the increase in pressure.
Pituitary gland and pressure
The pituitary gland is the central organ of the endocrine system and is part of the brain. Through its hormonal signals (tropines), all the endocrine glands of the human body are regulated. The anterior lobe (adenohypophysis) secretes, among others, adrenocorticotropic hormone, which regulates the adrenal glands.
The pituitary gland and hypertension are most often associated with the occurrence of its tumors.
In what diseases of the organs of the endocrine system does blood pressure change and how?
| Disease | Symptoms and Signs | Diagnostics | Differential diagnosis |
|---|---|---|---|
| Pheochromocytoma is a benign tumor of the adrenal medulla that produces adrenaline in large quantities. |
The disease manifests itself paroxysm. A sudden increase in pressure occurs when:
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| Cushing's syndrome and disease are a consequence of tumors of the adrenal and pituitary glands, respectively. Characterized by excess cortisol production. |
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| Hyperaldosteronism (Cohn's syndrome) - occurs with hyperplasia (increase in volume) of the adrenal tissue, or tumor growth in this area. |
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Addison's disease (adrenal insufficiency) - hormonal deficiency that occurs with hypoplasia of the glands, weak stimulation by the pituitary gland, as well as with the destruction of their tissue during tuberculosis, hemorrhages, autoimmune processes. |
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How to treat such changes in blood pressure?
It is useless to treat blood pressure in endocrine pathology until the provoking factor - the underlying disease - is removed. Symptomatic therapy is possible, but it will not give the same effect as surgical treatment.
| Disease | Drug treatment | Surgery |
|---|---|---|
| Pheochromocytoma | It is prescribed for preparation for surgery and in inoperable cases for palliative therapy. Beta and, less commonly, alpha blockers are used. | Laparoscopic tumor removal is the gold standard of treatment |
| Cushing's syndrome and disease | Symptomatic treatment of concomitant diseases. | The optimal treatment for the syndrome is to remove the adrenal tumor, and in case of illness, the pituitary tumor. |
| Hyperaldosteronism (Cohn's syndrome) | For inoperable forms, the diuretic Spironolactone is used. This remedy is contraindicated in men as it causes impotence and gynecomastia. Eplerenone is prescribed for them. Calcium channel blockers (Nifedepine) are actively used. Symptomatic therapy is acceptable. A low-salt diet is a must. | Removing the tumor is the best choice. |
Addison's disease (adrenal insufficiency) |
| No surgical treatment is provided |
How can the patient be further monitored after treatment?
Patients diagnosed with arterial hypertension of endocrine origin require the participation of several specialists in their treatment. Often, this is a family doctor, therapist or cardiologist, as well as an endocrinologist who will examine the adrenal glands in case of hypertension.
In addition, it is necessary to keep a diary, where the manifestations of the disease, the level of pressure, pulse, fluid intake, urine output, drugs taken and important notes that can help the doctor in correcting treatment will be recorded.
A separate place is occupied by women, since in most cases the question of pregnancy arises at some point. Nowadays, not a single self-respecting specialist will tell a patient that she is forbidden to become pregnant without having gathered a medical consultation. With timely surgical treatment and medication support, as well as under the supervision of a cardiologist and endocrinologist, family planning should not be hindered.
At the same time, if a woman does not plan children, or the state of her body does not allow this, reliable contraception is necessary.
What tests should I take?
Testing blood for hormones in laboratories is relatively expensive, so donating them yourself can be quite costly. The procedure can mislead both you and the doctor if the rules for preparing for blood sampling have been violated.
In the process of diagnostics, the doctor prescribes only the analyzes that are necessary at the moment, moving from simple to complex. He will also always tell you how best to pass each of them in order to get the most reliable result.
Conclusions
The adrenal glands and the high blood pressure caused by their dysfunction is a difficult but solvable medical problem. The symptoms of endocrine hypertension are nonspecific in themselves. Often, with timely detection, surgery can reduce the signs of hypertension. More difficult in terms of treatment and maintenance of the patient's quality of life is adrenal insufficiency, however, this problem can be solved with the help of modern endocrinological drugs in optimal dosages.
