Knowledge of the hormonal peculiarities of essential arterial hypertension may direct therapy and prevent errors.

The endocrine system becomes involved in the physiopathologic mechanisms of essential arterial hypertension (EAH) by the interference of hormones with the pressor and depressor substances. A "depressor" pharmacodynamic model with beta-blockers based on the variations of hormone-dependent data offers a series of characteristics for assessing the vasoconstrictive and volemic components, evolution (accelerated for instance) and treatment. Hormone data are also useful for avoiding errors and for increasing the efficiency and control of the therapy. It is not uncommon for EAH to become endocrine-dependent, for instance: increase in aldosterone secretion by activation of the renin-angiotensin (RA) system or of the hypophysis- corticoadrenal system and the adreno-sympathetic system, transforms the relatively "benign" evolution of EAH into an "accelerated" one. The incidence of hyperreactive corticoadrenal (with or without altered steroidogenesis), corticoadrenal hyperplasia or adenoma, is in reality higher than commonly diagnosed.

Natrium, potassium, cholesterol and total free 11-hydroxycorticosteroids variations in thymectomized and thymic extract treated rats.

The authors investigated the effect of thymectomy and TP2 thymic polypeptide extract administration on total, esterified and free cholesterol in the plasma and the adrenals, as well as on plasma Na and K and plasma free total 11-hydroxycorticosteroids. The results showed that total, esterified and free cholesterol decrease in the adrenals by 23.20%, 28.57% and 17.70% maximum respectively, in the thymectomized rat and that under the influence of the TP2 extract the values increase by 14.81%, 15.38% and 12.67%, respectively. Plasma cholesterol did not change. Thymectomy caused an increase in the plasma 11-hydroxycorticosteroids value by 13.4% and administration of the TP2 extract lowered their value by 58.11%. The plasma Na and K values did not change.

The level of urinary and plasma steroids after oral administration of cyclofenil to hirsute women with menstrual disorders and obesity.

Cyclofenil 600 mg/day was given to 10 women with excessive skin hair and marked excretion of urinary androgens. The urinary values of androgenic metabolites as well as the plasmatic values of radioimmunoassayable testosterone remained unaltered. A significant increase was noticed in the radioimmunoassayable plasma estradiol. Urinary total estrogens could not be assayed in the women under cyclofenil because of a non-specific color reaction. It was concluded that the estrogenic effects of cyclofenil are mediated, at least partly, by release of gonadotropins from the hypophysis.

Deviation of plasmatic aldosterone and significance of the stimulating (ACTH-cortrosyn) and inhibitory (propranolol) effects in hypertension and cardiovascular pathology.

Starting from the interference between the renin-angiotensin-aldosterone (RAA) system and cardiovascular pathology in arterial hypertension (AH) we have made a correlative study of the cardiovascular system and plasmatic aldosterone in normal and hypertensive subjects under conditions of stimulation (ACTH) and inhibition (propranolol). After administration of ACTH (one of the physiologic mediators of stress) increased values for plasmatic aldosterone were found. Negative cardiovascular effect: arrhthmia, angor, AH, cardiac asthma, under the condition of preexisting cardiovascular pathology or altered steroidogensis, were also noticed. Inhibition with propranolol does not have conclusive effects in AH with normal aldosterone. The best effect were noticed in that hypertension which implies the RAA pressor system in its pathogeny, irrespective of etiology, the reduction AT occurring in parallel with decline in plasmatic aldosterone values and total peripheral resistance (RPT). Administration of propranolol in AH with activated RAA system irrespective of etiology represents a pathogenic treatment able to prevent efficiently the major complications of AH.

Effect of a melatonin-free extract from bovine pineal on plasma and urinary steroids and on serum prolactin in hirsute amenorrheic adolescents.

Basal and post-suppressive dexamethasone (dxm) levels of some urinary androgen metabolites, plasma testosterone (T), 17 hydroxyprogesterone (17 OHP) and of basal serum prolactin were determined in 34 hirsute amenorrheic adolescents aged 13-17 in whom a five day course of bovine pineal extract (4 ml a day i.m.) was instituted. No convincing effect of pineal extract administration on plasma T and 17 OHP and on serum prolactin was detectable in most of pineal-treated patients. Suppressibility to dxm of plasma T and 17 OHP was not a relevant index of both the origin of androgens or the clinical course of the patients.

Variations of catecholamines in mixed shock. Therapeutic implications. Experimental and clinical investigations.

The variations of catecholamines, cortisol and aldosterone in mixed shock (traumatic, hemorrhagic and septic) were studied experimentally and clinically. In the stage of collapse adrenaline decreased by 81.4% and noradrenaline by 62.6% as compared with the preoperative values. These decreases were found to be directly proportional to the decrease of arterial blood pressure, pulse amplitude and diuresis as well as to the slowing down or even stop of microcirculation. The value of plasma cortisol increased in the stage of collapse by 98.3% and that of aldosterone by 66.27% as compared with the preoperative values. Treatment with a pharmacodynamic sympatheticolytic-vasopressor-adrenocortical mixture is recommanded when the blood pressure remains below 50--60 mm Hg for 1--2 hrs and when the treatment for the correction of hypovolemia with fluids and sympatheticolytics has failed. Clinically, this treatment gave good results in 34 of the 58 cases studied (58.6%).

Studies of the reproduction function in hyper- and hypoadrenocorticism.

The investigation was carried out on 66 patients with hypo- or hyperfunctional syndromes of adrenocorticism, hospitalized and treated by our team. The patients were grouped into 5 lots according to their diseases. Lot one consisted of 34 female patients with Cushing's syndrome, lot two of 10 males with Cushing's syndrome, lot three of 10 males with Addison's disease and lot four, of 6 females with androgenic hypercorticism. The morphofunctional disorders of reproduction were followed up clinically and by complex hormone assays, before and after treatment. The incidence of these disorders is very high, and the results of clinical observations and of laboratory data demonstrate that both the excess of adrenocortical hormones and the decrease in their circulating level have a negative influence on the reproduction function or represent a risk factor in cases of pregnancy. By the curative treatment of the adrenal cortex a preventive treatment of abortion and/or sterility is achieved.

[Severe essential arterial hypertension; the physiopathogenic role of the adrenal medulla. I. Population studies and experimental research]. / Hipertensiunea arteriala severa, rolul fiziopatogenic al medulosuprarenalei. Partea I. Studii populationale si cercetari experimentale.

The authors have carried out a populational study by performing psychomorphological and blood determinations, and have detected the presence of a chronic hyperactivity syndrome of the adrenals in 12,5 percent of the healthy young subjects engaged in various activities that they have investigated. In an experimental study the oxydative processes in the enzymatic cycle of Krebs were cut off by injecting the adrenal medullary area with a 40% solution of sodium salicylate, while the secretion of the adrenal cortex was maintained, as was demonstrated by the unaffected activity of the hexose monophosphate shunt in this tissue. The experimental results demonstrated that the adrenal medullary tissue represents a major pathogenetic link in the complex etiopathogeny of essential arterial hypertension, and this invalidates the role attributed by Volhard (in 1931) to the renal tissue, explaining the failure of haemodialysis, bilateral nephrectomy and kidney transplantation in preventing the recurrence of essential arterial hypertension.

Physiologic and pathogenic role of the adrenal medulla in severe essential arterial hypertension. Populational and experimental investigations. Therapeutic implications.

The syndrome of constitutional chronic hyperadrenalism was detected biochemically by blood cathecholamine assays as well as psychically and morphologically in 12.5% of the young apparently healthy subjects from Bucharest, investigated. Experimentally, the enzymatic cellular oxidative process in the adrenal medulla was blocked by chemical sclerosis of the adrenal medulla with a 40% solution of sodium salicylate (2.5 M), without influencing cortical secretion ensured bythe hexose monophosphat shunt. Chemical medullosclerosis associated with splanchnicosympathectomy and with or without suprarenalectomy on the opposite side performed in 60 patients with severe essential arterial hypertension resistant to drug therapy gave good results depending on the anatomical and clinical evolutive stage of disease.

The role of the renin-angiotensin system in arterial hypertension in hypercorticism.

The authors have studied on 25 cases of hypercorticism, one of the mechanisms of producing arterial hypertension, the renin-angiotensin system. The study showed that in only 20% of the cases plasma renin activity was high whereas in the remaining 80% other mechanisms were responsible for the hypertension. In the cases in which the plasma activity of renin was high, by studying the changes in the value of electrolytes we were able to derive some understanding of the mechanism of action of the RA2A system. Thus, the literature data show that sometimes the excess of glucocorticoids causes hypertension by activating directly the RA2A system and concomitently inhibiting the renin-kalikrein system (RKKS) and PgS; at other times, the excess of glucocorticoids is exerted on the same renin-angiotensin system, but via ACTH and ADH, the electrolytes values being those that demonstrate the borrowed mechanism.

[Severe arterial hypertension due to chronic constitutional hyperadrenalism. Splanchnic sympathectomy and left adrenal medulla sclerosis with 40 percent sodium salicylate (result after 3 years--genetic chemosurgery)]. / Hipertensiunea arteriala severa prin hiperadrenalinism cronic constitutional. Spanhnicosimpatectomie si meduloscleroza suprarenala stînga cu salicilat de sodiu 40% (rezultat dupa 3 ani--chimiochirurgie genetica).

The case is presented of a male patient hospitalized for severe arterial hypertension determined by chronic constitutional hyperadrenalism. Splanchnic-sympathectomy was performed, associated to medullar sclerosis of the left adrenal with 40% sodium salicylate (genetic chemical surgery). The results after 3 years were good, both clinically and paraclinically. The constitutional background was normo-hypoadrenergic and the ecologic balance of the patient became normal after surgery.

Hypercorticism--a risk factor in arterial hypertension and atherosclerosis.

The present work has attempted an analysis of the role hypercorticism as a risk factor in arterial hypertension and atherosclerosis. Our series consisted of 149 male and female patients of various ages. The incidence of cardiovascular disorders in relation to age and the glucidic lipidic metabolic disorders were also investigated. The results showed that hypercorticism may trigger in very young patients as well arterial hypertension (AH) and glucidic-lipid metabolic disorders both incriminated as risk factors in including atherosclerosis. Hypercorticism was proved to be an aggravating factor of pre-existing cardiopathy. Efficient management of adrenocortical hormones excess brings complete resolution of arterial hypertension and glucidic lipid metabolic disorders in young patients and most adult patients who had no cardiovascular complaints prior to the endocrine syndrome.

[Chemical medullosclerosis with 40-percent sodium salicylate, combined with splanchnicosympathectomy, with or without contralateral adrenalectomy, in severe essential arterial hypertension. II. Clinical, paraclinical and technical studies. Results for a period of 2 to 20 years (original concepts and therapy)]. / Meduloscleroza chimica cu salicilat de sodiu 40%, asociata cu splanhnicosimpatectomie, cu sau fara suprarenalectomie contralaterala, în hipertensiunea arteriala esentiala severa (partea a II-a).

Unilateral medullosclerosis associated with splanchnicosympathectomy was applied in 60 cases of severe essential arterial hypertension. In 21 patients this was associated with contralateral adrenalectomy. No deaths were recorded. The late results (2 to 20 years) varied in terms of the anatomoclinical stage of the disease when surgery was performed. Systolic pressures fell to 30-50 mm Hg, hypertensive oscillations disappeared, mean adrenalinaemia values decreased by 47.9% after unilateral medullosclerosis and slanchnicosympathectomy and by 72.2% after bilateral interventions in two stage. The constitutional hyperadrenergic psychosomatic background was modified and became normohypoadrenergic. There was no case of adrenocortical insufficiency, the secretion of corticoids being insured by activity of the hexose-6-mono-phosphate dehydrogenase shunt.