The pressure is rising dangerously and the drugs are not working. Cause unknown

The most common causes of high blood pressure are overweight, poor diet and lack of exercise. However, if treating high blood pressure does not work, it may turn out that the causes are different. Then it is worth examining the hormones. Their abnormal levels can cause high blood pressure that is difficult to counter with drugs.

1. We talk about hypertension when the pressure is permanently 140/90 mm Hg or more
2. Hypertension is an insidious disease that does not give any symptoms for many years
3. If left undiagnosed and untreated, it can lead to a heart attack, ischemic stroke and many other diseases
4. More information can be found on the Onet homepage

In some cases, hormones are responsible for treatment-resistant hypertension. Then a laboratory blood test confirms the excess of a given substance in the patient’s body. However, it is not known whether the left or right adrenal glands are responsible for the overproduction of the hormone. Or maybe both organs are not working properly or the hormone is secreted by a tumor present in a completely different part of the patient’s body? How to check? Nuclear medicine procedures come in handy: scintigraphic or PET examination, which allow to precisely identify the source of the problem and direct treatment.

Riddles of arterial hypertension

The adrenal glands are small paired glands that run deep within the abdominal cavity. Even though they measure only a dozen or so millimeters, they play a very important role in controlling various processes taking place in the body. Their functioning affects, among other things, blood pressure.

– The control function of the adrenal glands is carried out through the production of hormones important for the regulation of blood pressure. The adrenal gland is an organ composed of two zones: the medulla and the cortex. Each of them secretes different hormones; different in terms of chemical composition and function. If one of the zones increases in size, the secretion of one of the hormones is increased. If hormone secretion occurs out of control, one of the symptoms of the disorder is an increase in blood pressure. This type of hypertension is difficult to treat with standard pharmacological treatment, explains Prof. dr hab. n. med. Rafał Czepczyński from the Department and Clinic of Endocrinology, Metabolism and Internal Diseases, Medical University of Karol Marcinowski in Poznań, member of the Board of the Polish Society of Nuclear Medicine.

Hormones! But from where?

Sometimes a laboratory blood test confirms an excess of a given substance in the patient’s body, but it is not known whether the left or right adrenal glands are responsible for the overproduction of the hormone. Or maybe both organs are not working properly? It may also happen that a certain hormone is secreted by a tumor that is present in a completely different part of the patient’s body. How to check? Nuclear medicine procedures come in handy: scintigraphy or PET, which allow you to precisely identify the source of the problem.

For trouble: scintigraphy and PET

An endocrine clinic or a hospital ward, where laboratory and radiological examinations are performed, and the diagnosis is suspected based on the results, is referred to a scintigraphic or PET examination for the diagnosis of the adrenal glands of the patient. Depending on the test, diagnostics with the use of nuclear medicine procedures last from several dozen minutes to several days (with hospitalization or patient visits to the center several times a week in the case of testing with iodine-131, the half-life of which is 8 days).

– Both in the scintigraphy and in the PET scan, the patient is administered a radiopharmaceutical: a chemical compound containing a radioactive isotope in its structure. The isotopes most often used in the diagnostics of the adrenal glands are: iodine-123, iodine-131, fluorine-18, carbon-11, gallium-68. These isotopes emit radiation which is detected by gamma cameras or PET-CT scanners. These devices make it possible to create images of the distribution of radioactive substances inside the patient’s body. In connection with the technique of computed tomography (CT), which is a radiological technique, we are able to create fusion images – created by overlapping images created by two different techniques. This combination allows the allocation of a radiopharmaceutical in a specific focus to a specific lesion present in the adrenal glands. Thanks to this knowledge, we know where the hormone-releasing focus is located – explains Prof. Rafał Czepczyński.

To imitate natural processes

How exactly does a radiopharmaceutical work? As explained by prof. Rafał Czepczyński, this compound imitates nature: substances labeled with radioactive isotopes “impersonate” substrates, that is, molecules used to synthesize hormones. Physiological processes in the adrenal glands cause these substances to be incorporated into the adrenal lump just like natural substrates. As a result, after activating the device that detects radiation, doctors are able to assess whether a radioactive compound, specific for a given part of the adrenal gland, is accumulating in a given lesion. Excessive accumulation of substances in the test site indicates that the lesion is responsible for the excessive production of hormones and, for example, for hypertension.

– Since the optimal therapy in adrenal gland disorders is the surgical removal of the lump responsible for abnormal hormone production, the examination allowing to locate the lesion is the basis for properly selected therapy. Quite often in the older group of patients it happens that nodules of different sizes are present in both adrenal glands. Interestingly, in terms of their impact on the functioning and health of the body, these changes may be completely insignificant – in such cases, surgical intervention will not be necessary. A significant percentage of the adrenal gland lumps do not secrete any hormones – these are inactive adenomas: benign lesions that do not cause any symptoms. It also happens that these changes reach such dimensions that they put pressure on the neighboring structures, and therefore decisions are made to remove them – despite the lack of hormonal activity. The basis for deciding on a properly selected therapy is reliable knowledge about the source and nature of the problem – explains prof. Rafał Czepczyński.

Rich palette of therapies

As experts admit, adrenal surgery is a relatively technically difficult and burdensome procedure for the patient. The decision to perform adrenalectomy, i.e. removal of the adrenal gland, is made after a thorough analysis of all indications and contraindications.

– The doctor always takes into account the fact that in the event of removing both adrenal glands from the patient, he condemns the patient to lifetime complex hormone supplementation, which must sometimes be modified depending on the current health situation of the patient – says Prof. Rafał Czepczyński.

In the treatment arsenal of adrenal diseases, apart from surgical methods, pharmacotherapy, chemotherapy and nuclear medicine methods are used. Radiopharmaceuticals are used to treat, inter alia, pheochromocytomas, mainly their malignant forms (some cases of adrenal tumors are malignant, which means that they cause metastases (most often in the liver, but also in other organs). surgically (it would be difficult to safely remove all disease foci.) When disseminated disease is accompanied by excessive secretion of hormones, which cause a continuous increase in blood pressure, general therapy is necessary.

– One of the first treatments for disseminated phaeochromocytomas was the isotope method. The therapy is based on the fact that the patient is administered a compound that will accumulate not only in the adrenal gland, but also in the metastatic foci. Iodine-131 emits gamma radiation, but also beta radiation, which acts over a distance of a few millimeters, causing targeted cell damage. The compound that accumulates in the lesion will effectively inactivate cells throughout the lesion. The changes responsible for the excessive production of hormones are eliminated and the patient’s condition improves – explains Prof. Rafał Czepczyński.

Although adrenal lumps are more common in older people (both inactive and hormonally active), they can also develop in younger people. In the younger population, a genetic basis is a common cause of phaeochromocytomas.