| Sažetak | Arterijsku hipertenziju možemo podijeliti na primarnu i sekundarnu. Endokrini uzroci
hipertenzije pripadaju skupini sekundarnih hipertenzija. Iako čine samo manji dio u
ukupnoj prevalenciji hipertenzije nužno ih je pravovremeno prepoznati jer su
potencijalno izlječivi. Najpovoljnije liječenje endokrine hipertenzije je upravo
rješavanje same endokrinološke patologije, posebno kirurškim pristupom. U tu
skupinu ulaze primarni aldesteronizam, Cushingov sindrom, feokromocitom,
akromegalija, hipo/hipertireoza i sl. Primarni aldosteronizam je najčešći oblik
endokrine hipertenzije s prevalencijom 5-13% u hipertoničara. To je skupina
poremećaja karakterizirana visokom sekrecijom aldosterona, hipertenzijom,
hipokalijemijom, hipernatrijemijom, metaboličkom acidozom. Hipersekrecija
aldosterona izaziva hipertenziju djelovanjem na više organskih sustava. Metoda
liječenja unilateralnog PA je laparoskopska ekstirpacija adenoma ili žlijezde žlijezde, a
bilateralnog antagonistima mineralokortikoidnih receptora. U Cushingovom sindrom
nalazimo previsoke koncentracije hormona kore nadbubrežne žlijezde. Karakteristični
simptomi hiperkortizolizma su purpurne strije, atrofija kože, okruglo lice, proksimalna
mišićna slabost. Arterijska hipertenzija složene je etiologije i javlja se u oko 80%
pacijenata sa Cushingovim sindromom. Liječenje je u prvom redu kirurško.
Feokromocitomi su rijetki tumori kromafinih stanica koji luče katekolamine. Klasični trijas simptoma sastoji se od glavobolje, pojačanog znojenja i palpitacija. Trećina
pacijenata ima paroksizmalnu hipertenziju, polovina perzistentnu, ostali mogu biti
normotenzivni. Liječenje je kirurško, medikamentna terapija prije same operacije ima
veliku važnost kako bi se izbjegle potencijalno fatalne hipertenzivne krize.
Akromegalija je rijedak uzrok hipertenzije, to je kronična bolest karakterizirana ekscesivnom sekrecijom hormona rasta. Arterijska hipertenzija javlja su u 40%
bolesnika, dominatno je povišen dijastolički tlak. |
| Sažetak (engleski) | Hypertension can be divided into primary and secondary. The endocrine causes of
hypertension are primary aldosteronism, Cushing's syndrome, pheochromocytoma,
acromegaly, hypo/hyperthyroidism etc. They are classed as secondary hypertension.
Although they account for only a small part of the overall prevalence of hypertension
it is very important to diagnose them because they are potentally curable. The best
treatment approach for endocrine hypertension is treating its cause (endocrine
pathology), especially by surgery. Primary aldosteronism is the most common form
with prevalence of 5-13% in hypertensive patients. It is a group of disorders
characterized by excessive aldosterone secretion, hypertension, hypokalemia,
hypernatremia and metabolic acidosis. Aldosterone hypersecretion induces
hypertension by affecting several organ systems. Laparoscopic removal of adenoma
or entire gland represents the elective treatment in unilateral PA variants. Patients
with bilateral autonomous aldosterone production should be treated with mineralocorticoid receptor blockers. Cushing's syndrome is characterized by
excessive secretion of hormones produced in the adrenal cortex. Characteristic
symptoms of hypercortisolism are stretch marks, skin atrophy, moon face and
proximal muscle weakness. The etiology of arterial hypertension is complex and it
occurs in approximately 80% of patients with Cushing's syndrome.
Pheochromocytomas are rare catecholamine-secreting tumors. The classic triad of
symptoms consist of headaches, excessive sweating and palpitations. One third of
patients have paroxysmal hypertension, half have persistent, and others may be
normotensive. Surgical resection of the tumor is the treatment of choice. Careful
preoperative management is required to control blood pressure and prevent
intraoperative hypertensive crises. Acromegaly is a rare cause of hypertension, it is a chronic disease characterized by excessive secretion of growth hormone.
Hypertension occurs in 40% of patients with predominantly elevated diastolic
pressure. |
