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Uncontrolled High Blood Pressure: Overproduction of adrenal hormones can cause pressure to skyrocket even with medications.

The vast majority of people with high blood pressure (a.k.a. hypertension) have what's called primary or essential hypertension. In medical terms, that refers to high blood pressure for which no cause can be found. About 10 percent of patients have "secondary hypertension," meaning they have an underlying disorder that causes blood pressure to be high. Adrenal disorders are among those secondary causes, and with surgery the patient's blood pressure may return to normal.

"Most patients are diagnosed with high blood pressure between ages 30 to 55," says endocrine surgeon Masha Livhits, MD, assistant professor of surgery, UCLA Medical Center. "If someone had normal blood pressure and then all of a sudden developed high blood pressure later in life (after age 55), this is suspicious of a secondary underlying cause, such as an adrenal nodule producing too much hormone."

If you're taking three or more blood pressure medications and are still having difficulty with blood pressure control, the first step is to evaluate medications and doses. "Some patients are on multiple blood pressure medications, but perhaps not the best ones for them or not at optimal doses, and this may be why the blood pressure is still not well controlled," explains Dr. Livhits.

The Silent Assailant

High blood pressure is often referred to as the silent killer because many people may not realize they have it, nor the damage that it can cause. Blood pressure is the force of blood pushing against your arteries. Excessive force for a long time can damage arteries, leaving a person at increased risk for heart disease and stroke, the leading causes of death in the United States. According to the Centers for Disease Control and Prevention, high blood pressure affects one in three American adults, yet only half of those with high blood pressure have their condition under control.

Adrenal Causes of HBP

The adrenal glands look like small hats sitting atop the kidneys. The glands release various hormones into the bloodstream that affect many parts of the body. Normally, the adrenal glands communicate well with the brain to produce the right amount of hormone that's needed for the body.

"But if you have an adrenal nodule [a typically benign tumor], too much hormone may be produced," says Dr. Livhits. "And that can become a problem."

Excessive amounts of mineralocorticoids (mainly aldosterone), glucocorticoids (primarily Cortisol), and catecholamines (mostly epinephrine and norepinephrine, also called adrenaline) can interfere with blood pressure regulation. Medications can help rebalance hormones, but surgery is the better course for most patients.

Aldosterone regulates blood pressure and electrolyte balance. Too much of it causes the body to retain salt and water, which increases blood pressure. In addition, you can excrete too much potassium, resulting in low potassium levels in the bloodstream. If the tumor is in only one gland, the gland can be removed, and the cure rate is 35 to 65 percent. Blood pressure is improved in 90 percent of patients, and potassium levels return to normal in almost all cases. If both of the adrenal glands are producing too much aldosterone (called adrenal hyperplasia), the recommended treatment is medication rather than surgery, to avoid leaving the patient without any adrenal glands.

Cortisol's job is to control the metabolism of proteins, fats, and sugars. Too much Cortisol can cause obesity, diabetes, Cushing's syndrome, and high blood pressure. Left untreated, patients with excessive Cortisol levels have a greater risk of cardiovascular diseases. The majority of patients have some improvements in their weight, diabetes, and blood pressure after surgery.

Adrenaline is the fight-or-flight hormone released during times of stress. Symptoms of excess adrenaline include headache and racing heart rate during times of no stress, for example just watching TV. As in the other cases, the recommended treatment is surgery.

Surgery: Laparoscopic Adrenalectomy

Most of Dr. Livhits's patients who have this surgery are in their 60s, 70s, and 80s, and they do very well. "It is important for their medical doctor or cardiologist to do a good preoperative medical clearance, where they evaluate their heart and lungs and make sure there is no serious comorbid condition that would increase the risks of surgery," she says. "Contraindications are conditions which would significantly increase the risks of general anesthesia, such as recent heart attack or severe pulmonary disease on home oxygen."

Surgeons typically remove the whole gland rather than just the tumor to avoid recurrence. The remaining adrenal gland will, in time, produce all the hormones needed. If your blood pressure is not well controlled and you're taking multiple medications, talk with your doctor about possible underlying causes.
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Title Annotation:HEART
Publication:Healthy Years
Date:Mar 1, 2019
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