Hematuria, human health

My blood pressure is going wrong!

Recently, a patient came to Beijing Hospital for treatment because he found that his blood pressure was high. After the internal medicine outpatient doctor ordered a series of blood tests, he told the patient that he needed further examination of his adrenal glands.

I believe that after reading this, many people will have questions: Why do people with high blood pressure need to check their adrenal glands?

1. Is high blood pressure related to the adrenal glands?

Hypertension is divided into primary hypertension and secondary hypertension. Secondary hypertension refers to elevated blood pressure caused by certain diseases or causes, accounting for about 5% of all hypertension. Some secondary hypertension, such as primary aldosteronism and pheochromocytoma, originate from the adrenal glands. Such patients often have poor medication effects or require the combined use of multiple drugs, which not only increases side effects and economic burdens, but also increases the risk of target organ damage. Therefore, in the diagnosis and treatment of hypertension, it is also important to exclude secondary hypertension caused by adrenal sources.

2. What are the adrenal glands?

The adrenal glands are endocrine organs in the human body, one on each side, divided into the adrenal cortex and adrenal medulla, which are independent endocrine glands.

Cortical secretion includes mineralocorticoids, glucocorticoids and sex hormones. The main representative of mineralocorticoids is aldosterone, which regulates electrolyte and water-salt metabolism. When aldosterone secretion increases, the reabsorption of water and sodium by the distal convoluted tubules and collecting ducts of the kidneys increases, and the excretion of potassium increases, leading to hypertension and hypokalemia. Glucocorticoids have a weaker mineralocorticoid effect, which can retain sodium and excrete potassium. Long-term elevated hormone levels can lead to hypertension.

The adrenal medulla secretes adrenaline and norepinephrine. The main function of the former is to act on the myocardium to speed up and strengthen the heartbeat; the main function of the latter is to contract the smooth muscle of the arterioles, thereby increasing blood pressure.

3. Which hypertensive patients need to be screened for adrenal disease?

Those who meet the following conditions need to be screened for secondary hypertension in detail:

(1) Young patients with moderate to severe hypertension;

(2) Patients with suspicious clues in symptoms, signs or laboratory tests, such as asymmetric weakening or disappearance of limb pulses, rough vascular murmurs heard in the abdomen, etc.

(3) The effect of combined drug treatment is poor, or the disease was once well controlled during treatment but has increased significantly recently;

(4) Patients with rapid and malignant hypertension and severe target organ damage;

(5) The following symptoms occur on a regular basis: muscle weakness, periodic paralysis of the limbs; obvious intolerance to heat, sweating, and weight loss; paroxysmal hypertension accompanied by headaches, palpitations, and repeated apnea or breath holding during sleep;

(6) Unexplained abnormal renal function, abnormal blood count, electrolyte imbalance, endocrine dysfunction, unequal kidney size, and incidental adrenal tumors are found during physical examination.

Stay tuned

After reading this, I believe you have a certain understanding of what kind of hypertensive patients need to check their adrenal glands. Next time, we will further popularize what examinations are needed for secondary hypertension of adrenal origin.

Written by: Yan Qiuxia

Source: Authorized release from the official WeChat account of Beijing Hospital Urology Department