Hypertension and adrenal disorders.
Hypertension and adrenal disorders.
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DOI：
10.1097/00041552-199303000-00015
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发表时间：
1993-03
影响因子：
3.2
通讯作者：
J. Blumenfeld
中科院分区：
文献类型：
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作者：
J. Blumenfeld
肾上腺皮质和髓质功能紊乱是成人高血压的重要原因。盐皮质激素性高血压，以自发性低钾血症伴尿钾过多和血浆肾素活性降低为特征，最常见的是由醛固酮腺瘤引起，较少见的是由非腺瘤性肾上腺增生引起。然而，最近的证据表明，这种分类过度简化了这种综合征的病理生理多样性。类固醇生物化学和分子生物学的进展提高了我们识别各种形式盐皮质激素高血压患者的能力，也提供了他们被低估的证据。嗜铬细胞瘤最常见于肾上腺髓质，在那里它们可能过度产生去甲肾上腺素或肾上腺素。去甲肾上腺素、肾上腺素及其代谢产物的适当筛查至关重要，因为仅分泌肾上腺素的肿瘤可能不伴有高血压，因此可以被忽略。肾上腺外嗜铬细胞瘤比以前认为的更普遍，并造成特殊的问题，因为它们可能是多中心的，难以定位，更可能是恶性的比肾上腺嗜铬细胞瘤。
Abnormalities of adrenal cortical and medullary function are important causes of hypertension in adults. Mineralocorticoid hypertension, characterized by spontaneous hypokalemia with excessive kaliuresis and low plasma renin activity, is most commonly caused by aldosterone-producing adenoma or, less frequently, by nonadenomatous adrenal hyperplasia. However, recent evidence indicates that this classification oversimplifies the pathophysiologic diversity of this syndrome. Advances in steroid biochemistry and molecular biology have improved our ability to identify patients with various forms of mineralocorticoid hypertension and also provide evidence that they are underdiagnosed. Pheochromocytomas are most commonly located in the adrenal medulla, where they may overproduce norepinephrine or epinephrine. Appropriate screening of norepinephrine, epinephrine, and their metabolites is essential because tumors that secrete epinephrine exclusively may not present with hypertension and, thus, can be overlooked. Extra-adrenal pheochromocytomas are more prevalent than previously considered and pose special problems because they may be multicentric, difficult to locate, and more likely to be malignant than are adrenal pheochromocytomas.