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Components of our body - renin, angiotensin, aldosterone system - play the role of a valve that regulates blood volume and level blood pressure. The way renin works looks the same as how a stream of water from a watering hose behaves when we water the beds. If we squeeze the tip of the hose with our fingers, the stream of water becomes thinner, but hits with greater pressure.

The hormones renin-angiotensin, or more precisely, the aldosterone-renin ratio of these hormones, also act on our blood system: as soon as the pressure of our blood in the body decreases, the components of the aldosterone system, through complex biochemical reactions, force it to contract blood vessels and thereby increase blood pressure.

The group of hormones renin-angiotensin is synthesized by the adrenal cortex, therefore all major disturbances in the concentration of this hormone are often associated with pathologies of the adrenal cortex or directly by the kidneys. And high or low levels of these hormones can cause a number of diseases, usually related to abnormal blood pressure levels.

A referral for analysis of the hormone renin is most often caused by the detection of hypertensive diseases, tumor diseases of the adrenal cortex, and renal failure.

Elevated renin levels represent more serious danger than low hormone levels. Pathologies associated with high renin have consequences in a wide variety of human organs, but the cardiovascular system and kidneys suffer the most.

Hypertension. An insidious disease caused by persistent high blood pressure. This disease, especially in youth, may not manifest itself for many years, but secretly slowly eats the heart, liver and brain. If symptoms do exist, they are usually dizziness, rapid pulse, and ringing in the ears.

In everyday life, our blood pressure often “jumps”, for example, during physical activity, drinking alcohol or strong experiences. And if a person already suffers from hypertension, then this additional increase pressure may have severe consequences, even death.

After 45 years, varying degrees of this disease are present in 70% of people, this is due to age-related narrowing of blood vessels. Unfortunately, renin knows nothing about this and continues to carefully and pedantically perform its function - as soon as the pressure drops a little, the hormone, intensively released from the adrenal cortex, increases the already high pressure.

The risk of hypertension increases significantly if the patient or his immediate family suffers from diabetes or obesity. These three diseases are obesity, diabetes and hypertension almost always go hand in hand, and treatment requires an integrated approach.

Kidney damage. This complex of diseases, caused by high renin, is due to the peculiarities of the structure and operation of the urinary system, more precisely, that part of it that is associated with blood purification. The kidneys are made up of huge amount microscopic blood filters - nephrons, which tirelessly filter day and night, passing hundreds of liters of blood through themselves, releasing dangerous, toxic, pathogenic and useless elements from it.

Filtration occurs when the blood passes through a thin membrane, which adsorbs all harmful elements, and they are discharged into the bladder. What happens when renin increases blood pressure?

Our kidneys, working non-stop 24 hours a day, already do almost back-breaking work, passing through themselves up to 1500 liters of blood per day, and now, when the vessels narrow, the blood flow circulates even faster. In addition, high blood pressure increases pressure on the membrane and when hypertension continues for many months, the membrane eventually cannot withstand it and ruptures.

This pathology of the kidney nephrons leads to sad consequences. A big risk now is the possibility of toxic substances and proteins getting into the blood. The water-salt and potassium balance in the body is disrupted, and kidney inflammation may begin, caused by damage to the nephron substance.

Congestive heart failure. The disease is associated with the inability of the heart to pump large volumes of blood caused by high blood pressure. The cause of high blood pressure in this case is still the same renin. At the initial stages of the disease, patients complain of:

severe shortness of breath even with slight physical activity,
muscle weakness,
rapid heartbeat, arrhythmia, tachycardia,
inflammation of the mucous membranes of the eyes, genitals,
numerous swelling of body parts associated with the accumulation of large volumes of fluid.

Further progression of the disease without proper treatment leads to numerous kidney pathologies, and the liver becomes dense, increases in size and in some cases is painful on digital examination.

With this disease, a significant dose of alcohol can kill a person, and failure to follow a diet that excludes fatty and spicy foods can lead to complete refusal liver. Patients now experience shortness of breath even at rest, and they can only sleep in a semi-sitting position due to a feeling of lack of air.

The absorption function of the intestine is impaired, causing diarrhea, up to constant diarrhea. Swelling after sleep intensifies and no longer goes away, as before, by midday. The disease gradually turns into so-called cachexia, and if drug therapy does not achieve results, patients die. This is how dangerous the hormone renin can be when its level is significantly and long-term elevated in the human body without proper treatment.

Primary hyperaldosteronism. The disease is based on increased production of the hormone aldosterone by the adrenal cortex, caused by a decreased level of the renin-angiotensin hormone group. It is quite rare to diagnose the disease at the initial stage due to the absence of symptoms, with the exception of mild hypertension. The cause of primary hyperaldosteronism may be adrenal cancer and other tumor diseases of the kidneys.

Under the influence of decreased renin, excessive amounts of sodium begin to be retained and excessive amounts of potassium are excreted. This leads to the accumulation of large amounts of water in the body, without the ability to exit through the urinary canals. The huge amount of fluid that accumulates in the body immediately causes severe swelling in many parts of the body, increased fatigue and high blood pressure.

Renin – important component, affecting the functioning of our body. Thanks to its functioning, the body controls blood pressure levels and also regulates the volume of circulating blood.

Many people call the renin valve, the operating pattern of which can be described as the functioning of a watering rod: if you reduce the diameter of the duct, the flow force becomes much greater. However, the jet itself becomes smaller. Renin is secreted by the kidneys, which means renal component in Latin.

The juxtaglomerular apparatus - special cells of the kidneys - is located in the arterioles, which are located in the renal glomerulus. Thanks to these cells, prorenin is released into the body.

Under the influence of blood cells, it is converted into renin. A large number of cells of this nature control the amount of blood that flows to the renal nephrons. However, this controls the volume of fluid that enters the kidneys, as well as the sodium content in it.

What triggers the production of renin:

Stressful conditions;
Reduced amount of blood that circulates throughout the body;
Decreased blood supply to the renal ducts;
Low levels of potassium or sodium in the blood;
Low blood pressure.

Thanks to renin, the body breaks down the protein that is synthesized by the liver, angiotensin of the first degree. Subsequently, it splits into the second level, which provokes a contraction of the muscular layer of the arteries. As a result of such changes in the body, blood pressure levels increase, which provokes an acceleration in the release of the hormone aldosterone in the adrenal cortex.

In addition, the hormone renin-angiotensin, doctors call it aldosterone-renin, can change the functioning of the blood system. It is also called hormone ratio.

It works as follows: as soon as the blood pressure level increases, hormones are released - therefore, it begins to slowly decrease. Due to the biochemical reactions taking place, the body’s blood vessels begin to contract, thereby causing blood pressure levels to rise.

Special renin-angiotin hormones are produced in the required quantities by the adrenal cortex. In this regard, it is fair to note that a low or high concentration of this hubbub may signal the presence of any pathologies in the adrenal cortex or in the kidneys themselves.

Additionally, an elevated or decreased level indicates abnormal blood pressure levels on an ongoing basis. In most cases, doctors send for analysis of renin levels due to the detection of tumor formations in the adrenal cortex, detection of hypertensive diseases or renal failure.

An increased level of renin in human blood is more dangerous than a decreased one - it represents high risk the occurrence of serious complications, the appearance of chronic pathologies. The appearance of the latter due to decreased renin levels affects the functioning of internal organs, the cardiovascular system, as well as the kidneys, suffer the most due to this disorder.

- insidious and dangerous disease, which is manifested by a constantly elevated level of blood pressure in a person. Its main danger is that early stages it does not manifest itself in any way - characteristic symptoms appear after hypertension becomes a serious illness

in the human body and complications appeared

Hypertension strikes suddenly, it causes irreparable harm when a person does not understand anything. The only thing that can be felt in the early stages is a rapid pulse, tinnitus, dizziness and headache.

No one can be surprised by the constantly fluctuating blood pressure - life in a metropolis changes health standards. In addition, it is influenced by the frequency of use alcoholic drinks, level of physical activity, stressful situations.

In addition, a person who suffers from arterial hypertension, increased blood pressure due to certain factors leads to death or serious complications.

70% of people over the age of 45 have cardiovascular diseases various stages. This statistics is due to age-related changes in the body - blood vessels narrow and blood pressure levels rise.

At the same time, the volume of renin that is present in the body cannot perform its direct functions. If the pressure level drops even a little, the body begins to secrete renin - the already high pressure begins to rise.

If immediate family members are overweight and have high blood glucose levels, the risk of hypertension increases significantly. All these ailments follow each other, complicating the course of the disease. The disease can only be overcome if integrated approach to treatment.

Elevated renin levels can cause kidney damage of varying severity. It affects the functioning of the urinary system, in particular the structure that is responsible for purifying the blood. Nephritis - microscopic filters - constantly monitor the composition of the blood fluid; in one day they process more than 100 liters.

Thanks to its work, it isolates and separates pathogenic and toxic elements from the blood - making the blood safe for the body. A thin membrane tube is responsible for everything - it cleanses the blood, and harmful substances transmitted to the bladder.

The kidneys are an organ that constantly works at full capacity. Thanks to them, the body filters more than 1.5 tons of blood fluid in 24 hours. If the blood vessels narrow, the rate of fluid circulation throughout the body increases significantly.

It is worth noting that due to an increase in the speed of blood flow in the body, the membrane membrane experiences heavy loads– if treatment is not started in time, it cannot withstand the constant pressure and ruptures.

Serious kidney damage of this nature sooner or later leads to sad consequences. The risk of toxic waste substances being released into the blood increases. Because of this, disturbances in potassium and water-salt balances occur, which leads to serious inflammation of the kidneys and damage to the nephrons.

Due to high blood pressure and the inability to pump a large volume of blood, heart failure occurs. All these manifestations can be caused by improper action of the hormone renin. At the very beginning of the disease, the patient notices the following changes in the body:

The appearance of muscle weakness;
The mucous membranes of the entire body become inflamed;
Severe shortness of breath appears even with light exertion;
Tachycardia or arrhythmia appears;
Due to fluid retention, numerous swelling occurs.

Without complex treatment pathology, it progresses and causes numerous lesions of the kidneys and adrenal cortex, in addition, the condition of the liver is disturbed: it becomes larger, thickens, and serious pain occurs on palpation. If the renin level is not brought back to normal in time, there is a high probability of developing serious illnesses many organs and systems. An increase in renin provokes the production of bilirubin, which large quantities leads to non-alcoholic cirrhosis.

Without proper treatment, even a small dose of alcohol with elevated renin levels can lead to complete liver failure. The picture gets worse if a person consumes large amounts of fatty and spicy foods.

Shortness of breath appears - it torments a person not only during physical activity, but also at rest. If drug therapy is not prescribed in time, there is a high probability of death. Try to lead a healthy lifestyle, and then no illness will spoil your mood.

If the body's production of renin is impaired, the adrenal cortex begins to produce more aldosterone. Due to the absence of special symptoms, it is quite difficult to identify the disease in the initial stages; the only thing that should alert you is a sharp increase in blood pressure. Tumor diseases, mainly adrenal cancer, can cause a decrease in renin production.

Due to a decrease in the amount of renin in a person’s blood, the body cannot get rid of sodium and excretes an excessive amount of potassium. As a result, a large amount of fluid is retained in the body rather than exiting through the urinary canals. Large volumes of fluid cause severe swelling and increased fatigue. In addition, blood pressure levels increase sharply.

1 Factors causing hormone release

Reasons why renin is released:

If smooth muscle cells receive a signal about a decrease in pressure, they begin to actively produce the substance.
Sympathetic stimulation of juxtaglomerular cells. In turn, the sympathetic nervous system is activated by emotional stress, depression, and fear. Any severe stress provokes the production of renin.
Low concentration of salt in urine.

All these processes occur in the kidneys, but other organs take part in the regulation of pressure. One of them is the liver - the most important filter of the human body. The cells of the organ also produce a hormone (angiotensinogen), which in its natural original form is dormant and absolutely useless. The substance circulates in the bloodstream, where it is in an inactive form. To activate it, another hormone is needed that would interact with it. This is renin, which reacts with angiotensinogen and turns into angiotensin 1.

Renin is an enzyme that cleaves off a larger segment of the angiotensinogen molecule. Angiotensin 1 is an active compound that, once inside the vessel, forms angiotensin 2, a hormone that is considered very active. It takes part in the most important processes in the body, one of which is an increase in blood pressure. The substance also causes smooth muscles to contract, increasing resistance.

Angiotensin acts on kidney cells, causing the paired organ to reabsorb more water, resulting in an increase in the volume of circulating blood. This helps to increase systolic volume.

This compound, activated by renin, affects the function of the pituitary gland, which is one of the main organs for the secretion of hormones. It also enhances the work of the adrenal glands, which, under the influence of angiotensin 2, secrete aldosterone. All these hormones have one big function in common - maintaining a constant volume of circulating blood.

2 Why does the hormone level increase?

If renin in the bloodstream is elevated, this may indicate some kind of disorder or disease. In particular this state may be due to:

reduction of extracellular fluid, limitation of water consumption;
deterioration of hematopoiesis;
lack of salt in the diet;
pathology in the right ventricle of the heart and lack of its functioning;
nephrotic syndrome;
liver cirrhosis;
Addison's disease;
hypertension;
narrowing of the renal artery;
neuroblastoma;
kidney oncology;
hemangiopericytoma.

Renin in the blood decreases with excess salt in the diet, increased secretion of antidiuretic hormone, acute renal failure, and Conn's syndrome. In women, a decrease in the level of the substance is observed during the period of bearing a child, which is rather a short-term condition that does not require correction.

Renin may be increased while taking diuretics, corticosteroids, prostaglandins, estrogens, Diazoxide or Hydralazine. If the hormone is elevated, it is not necessary to immediately suspect the presence of a disorder in the body. Perhaps the reason lies in some medications that the person took the day before the test. Renin may decrease after taking Propranolol, Indomethacin, Reserpine, etc.

3 When should you take a hormone test?

Donating blood for a hormonal test is carried out only if there are certain indications: an increase in blood pressure, a poor result or lack thereof in the treatment of hypertension, if an increase in blood pressure is observed in young people.

Despite the fact that renin is not a full-fledged hormone, it is necessary to prepare for the tests very carefully in order to get the correct results. If this is not done, the level of the substance may be increased or decreased, but will not correspond to the true indicators.

The rules for preparing for the study are quite simple:

The day before testing, you should completely avoid drinking alcohol.
Blood is taken for analysis on an empty stomach. At least 10 hours must have passed since your last meal.
The day before the test, you must stop taking certain medications, after consulting with a specialist.
On the eve of the test, you should avoid any physical activity (hard work, going to the gym). Emotional condition should be stable and calm.
Before donating blood, you need to be in a horizontal position for at least 40 minutes.
Smoking is prohibited before the test.

If a person accepts medicines according to a scheme that cannot be interrupted, you need to inform the doctor who will take the blood. The specialist will definitely record this and take it into account when deciphering the indicators. If, according to the results of the study, renin is elevated, they will most likely prescribe additional research and diagnostics of internal organs.

When calculating renin, the norm in women ranges from 3 to 39.9 µIU/ml. These indicators may vary depending on the position in which the blood was taken. To determine the complete picture of the patient’s condition, aldosterone and cortisol contained in the body are examined.

If the renin analysis indicators deviate from the norm, the adrenal cortex is diagnosed, the liver is examined, etc. Then treatment is prescribed in accordance with established diagnosis. If there are disturbances in the functioning of the adrenal glands, taking medications or removing glandular organs is indicated. In other cases, therapy is determined according to the situation.

In today's article we will discuss problems that relate to endocrine causes of hypertension, i.e. blood pressure rises due to excessive production of some hormone.

Article outline:

First, we'll list the hormones that can cause problems, and you'll learn what role they play in the body when everything is normal.
Then we’ll talk about specific diseases that are included in the list of endocrine causes of hypertension
And most importantly, we will provide detailed information about the methods of their treatment.

I have made every effort to explain complex medical issues in simple terms. I hope this was more or less possible. The information on anatomy and physiology in the article is presented in a very simplified manner, not detailed enough for professionals, but just right for patients.

Pheochromocytoma, primary aldosteronism, Cushing's syndrome, thyroid problems and others endocrine diseases- the cause of hypertension in approximately 1% of patients. These are tens of thousands of Russian-speaking patients who can be completely cured or at least alleviate their hypertension if smart doctors take care of them. If you are diagnosed with hypertension due to endocrine causes, then you will definitely not be able to cure it without a doctor. Moreover, it is extremely important to find a good endocrinologist, and not to be treated by the first one you come across. You will also find it useful general information about treatment methods, which we present here.

The pituitary gland (synonym: pituitary gland) is a round-shaped gland located on the lower surface of the brain. The pituitary gland produces hormones that affect metabolism and, in particular, growth. If the pituitary gland is affected by a tumor, then this causes increased production of some hormone inside it, and then “along the chain” in the adrenal glands, which it controls. A pituitary tumor is often the endocrinological cause of hypertension. Read more below.

The adrenal glands are glands that produce various hormones, including catecholamines (adrenaline, norepinephrine and dopamine), aldosterone and cortisol. There are 2 of these glands in humans. They are located, as you might guess, on top of the kidneys.

If a tumor develops in one or both adrenal glands, it causes excessive production of a hormone, which in turn causes hypertension. Moreover, such hypertension is usually stable, malignant and cannot be treated with pills. The production of some hormones in the adrenal glands is controlled by the pituitary gland. Thus, there is not one, but two potential sources of problems with these hormones - diseases of both the adrenal glands and the pituitary gland.

Hypertension can be caused by excessive production of the following hormones in the adrenal glands:

Catecholamines - adrenaline, norepinephrine and dopamine. Their production is controlled by adrenocorticotropic hormone (ACTH, corticotropin), which is produced in the pituitary gland.
Aldosterone is produced in the zona glomerulosa of the adrenal cortex. Causes salt and water retention in the body, and also enhances the excretion of potassium. Increases circulating blood volume and systemic blood pressure. If there are problems with aldosterone, edema, hypertension, sometimes congestive heart failure, and weakness due to low potassium levels in the blood develop.
Cortisol is a hormone that has a multifaceted effect on metabolism, preserving the body's energy resources. Synthesized in the outer layer (cortex) of the adrenal glands.

The production of catecholamines and cortisol occurs in the adrenal glands under the control of the pituitary gland. The pituitary gland does not control the production of aldosterone.

Adrenaline is the hormone of fear. Its release occurs with any strong excitement or sudden physical activity. Adrenaline saturates the blood with glucose and fats, increases the absorption of sugar from the blood by cells, and causes vasoconstriction of the abdominal organs, skin and mucous membranes.

Norepinephrine is the rage hormone. As a result of its release into the blood, a person becomes aggressive, and muscle strength increases significantly. The secretion of norepinephrine increases during stress, bleeding, heavy physical work and other situations that require rapid restructuring of the body. Norepinephrine has a strong vasoconstrictor effect and plays a key role in regulating the speed and volume of blood flow.

Dopamine causes an increase in cardiac output and improves blood flow. From dopamine, under the action of enzymes, norepinephrine is produced, and from it adrenaline, which is the final product of catecholamine biosynthesis.

So, we’ve sorted out a little about hormones, now let’s list them directly endocrine causes hypertension:

Pheochromocytoma is a tumor of the adrenal glands that causes increased production of catecholamines. In 15% of cases it occurs not in the adrenal glands, but in the abdominal cavity or chest.
Primary hyperaldosteronism is a tumor in one or both adrenal glands that causes too much aldosterone to be produced.
Itsenko-Cushing syndrome, also known as hypercortisolism, is a disease in which too much cortisol is produced. In 65-80% of cases it is due to problems with the pituitary gland, in 20-35% of cases it is due to a tumor in one or both adrenal glands.
Acromegaly is an excess of growth hormone in the body due to a tumor in the pituitary gland.
Hyperparathyroidism is an excess of parathyroid hormone (parathyroid hormone), which is produced parathyroid glands. Not to be confused with the thyroid gland! Parathyroid hormone increases the concentration of calcium in the blood by leaching this mineral from the bones.
Hyper- and hypothyroidism are increased or decreased levels of thyroid hormones.

If you do not treat the listed diseases, but simply give the patient pills for hypertension, then this usually does not sufficiently reduce the pressure. To bring blood pressure back to normal and avoid heart attack and stroke, you need to participate in the treatment of a whole team of competent doctors - not just an endocrinologist, but also a cardiologist and a surgeon with golden hands. The good news is that treatment options for hypertension due to endocrine causes have expanded significantly over the past 20 years. Surgeries have become much safer and more effective. In some situations, timely surgical intervention allows you to normalize your blood pressure so much that you can stop taking regular pills for hypertension.

The problem is that all the diseases listed above are rare and complex. Therefore, it is not easy for patients to find doctors who can treat them conscientiously and competently. If you suspect you have hypertension due to an endocrine cause, then keep in mind that the endocrinologist on duty at the clinic will probably try to kick you off. He doesn’t need your problems for money, much less for nothing. Look for a smart specialist based on reviews from friends. Surely it will be useful to go to regional center, or even to the capital of your state.

Below is detailed information that will help you understand the course of treatment: why this or that activity is carried out, medications are prescribed, how to prepare for surgery, etc. Let us note that to date, not a single major serious study has been conducted among patients with endocrine hypertension. would meet the criteria of evidence-based medicine. All information about treatment methods, which is published in medical journals and then in books, is collected “from around the world.” Doctors exchange experiences with each other, gradually generalize them, and thus universal recommendations appear.

Pheochromocytoma is a tumor that produces catecholamines. In 85% of cases it is found in the adrenal medulla, and in 15% of patients - in the abdominal cavity or chest. It is extremely rare that a catecholamine-producing tumor occurs in the heart, bladder, prostate, pancreas or ovaries. In 10% of patients, pheochromocytoma is a hereditary disease.

Usually this is a benign tumor, but in 10% of cases it turns out to be malignant and metastasizes. IN? cases it produces adrenaline and norepinephrine, in? cases - only norepinephrine. If the tumor turns out to be malignant, it can also produce dopamine. Moreover, there is usually no relationship between the size of the pheochromocytoma and how abundantly it produces hormones.

Among all patients with arterial hypertension, approximately 0.1-0.4%, i.e., 1-4 patients out of 1000, are diagnosed with pheochromocytoma. In this case, the pressure may be elevated all the time or in attacks. The most common symptoms: headache, increased sweating and tachycardia (palpitations). If your blood pressure is elevated but these symptoms are not present, pheochromocytoma is unlikely to be the cause. There are also trembling hands, nausea, vomiting, visual disturbances, attacks of fear, sudden pallor or, conversely, redness of the skin. About y? Patients experience persistently or occasionally elevated levels of glucose in the blood and even sugar in the urine. At the same time, the person inexplicably loses weight. If the heart is affected due to increased levels of catecholamines in the blood, symptoms of heart failure develop.

Frequency of main symptoms in pheochromocytoma

It happens that pheochromocytoma occurs without pronounced symptoms. In such cases, the main complaints from patients are signs of tumor growth, i.e. pain in the abdomen or chest, a feeling of fullness, compression of internal organs. In any case, to suspect this disease, it is enough to simultaneously detect hypertension, high sugar in the blood and signs accelerated exchange substances in the background normal level thyroid hormones.

The symptoms of pheochromocytoma are not unambiguous; they vary from patient to patient. Therefore, it is impossible to make a diagnosis based solely on visual observation and listening to patient complaints. It is necessary to look for and identify biochemical signs of increased production of adrenaline and norepinephrine. These hormones are excreted in the urine in the form of vanilla-mandelic acid compounds, metanephrines (methylated products), and free catecholamines. The concentration of all these substances is determined in daily urine. This is a standard diagnostic procedure for suspected pheochromocytoma. Before undergoing tests, patients must first stop taking medications that increase or, on the contrary, inhibit the production of catecholamine hormones in the body. This the following drugs: adrenergic blockers, adrenergic stimulants, including centrally acting ones, MAO inhibitors and others.

If possible, compare the content of catecholamine metabolic products in the urine in a normal situation and immediately after a hypertensive crisis. It would be good to do the same with blood plasma. But to do this, one would have to take blood through a venous catheter, which must be installed 30-60 minutes in advance. It is impossible to keep the patient in a state of rest all this time, and then have him have a hypertensive crisis on schedule. A blood test from a vein is a stress in itself, which increases the concentration of adrenaline and norepinephrine in the blood and thus leads to false positive results.

Also, to diagnose pheochromocytoma, functional tests are used, in which the secretion of catecholamines is inhibited or stimulated. The production of these hormones can be inhibited with the medication clonidine (clonidine). The patient donates blood for analysis, then takes 0.15-0.3 mg of clonidine, and then donates blood again 3 hours later. The content of adrenaline and norepinephrine in both tests is compared. Or they check how much clonidine suppresses the nighttime production of catecholamines. To do this, tests are performed on urine collected overnight. In a healthy person, after taking clonidine, the content of adrenaline and norepinephrine in night urine will significantly decrease, but in a patient with pheochromocytoma - not.

Stimulation tests are also described, in which patients receive histamine, thyramione, and best of all, glucagon. Taking stimulant drugs in patients with pheochromocytoma significantly increases blood pressure, and the content of catecholamines increases several times, much stronger than in healthy people. To avoid a hypertensive crisis, patients are first given alpha-blockers or calcium antagonists. These are drugs that do not affect the production of catecholamines. Stimulation tests can only be used with great caution, because there is a risk of provoking a hypertensive crisis and cardiovascular accident in the patient.

The next stage in diagnosing pheochromocytoma is identifying the location of the tumor. To do this, computed tomography or magnetic resonance imaging is performed. If the tumor is in the adrenal glands, it is usually easily detected, often even with the help of ultrasound, which is the most accessible examination. But if the tumor is located not in the adrenal glands, but somewhere else, then whether it can be identified largely depends on the experience and will to win that the doctor will show. As a rule, 95% of pheochromocytomas are found in the adrenal glands if their size is more than 1 cm, and in the abdominal cavity if their size is more than 2 cm.

If a tumor cannot be detected using computed tomography or magnetic resonance imaging, then a radioisotope scan using a contrast agent has to be done. A substance that emits radioactivity is injected into the patient's blood. It spreads throughout the body, “illuminates” the vessels and tissues from the inside. Thus, the X-ray examination is more informative. Metaiodobenzylguanidine is used as a contrast agent. Radioisotope scans using contrast material may cause kidney failure and have other risks. Therefore, it is prescribed only in exceptional cases. But if the benefit is higher than the potential risk, then you need to do it.

They can also test for catecholamines in the blood that flows from the site of the tumor. If there was no mistake in identifying this location, then the concentration of hormones will be several times higher than in blood taken from other vessels. This analysis is prescribed if pheochromocytoma is found in the adrenal glands. However, this is a complex and risky analysis, so they try to do without it.

To treat pheochromocytoma, surgery is performed to remove the tumor if there are no contraindications. The good news for patients is that last years surgeons introduced laparoscopy. This is a method of performing operations in which the incision on the skin is very small and minimal damage is also caused inside. Thanks to this, recovery takes no more than 2 weeks, while previously it was an average of 4 weeks. After surgery, more than 90% of patients experience a persistent decrease or even complete normalization of blood pressure. Thus, the effectiveness of surgical treatment of pheochromocytoma is very high.

If it turns out that it is impossible to remove the tumor surgically, then it is irradiated, and chemotherapy is also prescribed, especially if there are metastases. Radiation and chemotherapy are called “conservative treatments,” that is, without surgery. As a result of their use, the size and activity of the tumor are reduced, due to which the condition of patients improves.

What blood pressure pills are prescribed for pheochromocytoma:

alpha-blockers (prazosin, doxazosin, etc.);
phentolamine - intravenously, if necessary;
labetalol, carvedilol - combined alpha and beta blockers;
calcium antagonists;
centrally acting drugs - clonidine (clonidine), imidazoline receptor agonists;
Methyltyrosine is a dopamine synthesis blocker.

The anesthesiologist is advised to avoid fentanyl and droperidol during surgery because these drugs may stimulate additional catecholamine production. The function of the patient’s cardiovascular system should be carefully monitored at all stages of surgical treatment: during induction of anesthesia, then during the operation and the first day after it. Because severe arrhythmias, a strong decrease in blood pressure, or vice versa are possible hypertensive crises. In order for the circulating blood volume to remain sufficient, the patient must receive enough fluid.

It is recommended to take a urine test for catecholamines 2 weeks after surgery. Sometimes, over time, the tumor recurs or additional pheochromocytomas are discovered, in addition to the one that was removed. In such cases, repeated surgical operations are recommended.

Let us recall that aldosterone is a hormone that regulates water and mineral metabolism in the body. It is produced in the adrenal cortex under the influence of renin, an enzyme synthesized by the kidneys. Primary hyperaldosteronism is a tumor in one or both adrenal glands that causes too much aldosterone to be produced. These tumors can be of different types. In either case, excess aldosterone production causes blood potassium levels to drop and blood pressure to rise.

Causes and treatment of primary hyperaldosteronism

To understand what primary hyperaldosteronism is, you need to understand how renin and aldosterone are related. Renin is an enzyme that the kidneys produce when they sense that blood flow to them is decreasing. Under the influence of renin, the substance angiotensin-I is converted into angiotensin-II and the production of aldosterone in the adrenal glands is also stimulated. Angiotensin-II has a powerful vasoconstrictor effect, and aldosterone increases sodium and water retention in the body. Thus, blood pressure rises rapidly simultaneously through several different mechanisms. At the same time, aldosterone suppresses further production of renin so that the pressure does not go off scale. The more aldosterone in the blood, the less renin, and vice versa.

This is called the renin-angiotensin-aldosterone system. It is a feedback system. Let us mention that some medications block its action so that blood pressure does not increase. ACE inhibitors interfere with the conversion of angiotensin I to angiotensin II. Angiotensin II receptor blockers prevent this substance from exerting its vasoconstrictor effect. And there is also the newest drug - the direct renin inhibitor Aliskiren (Rasilez). It blocks the activity of renin, i.e. it acts at an earlier stage than the drugs we mentioned above. All this does not matter direct relationship to the endocrinological causes of hypertension, but it is useful for patients to know the mechanisms of action of drugs.

So, aldosterone in the adrenal glands is produced under the influence of renin. Secondary hyperaldosteronism is when there is too much aldosterone in the blood due to excess renin. Primary hyperaldosteronism - if the increased production of aldosterone by the adrenal glands does not depend on other reasons, and the activity of renin in the blood plasma is definitely not increased, but rather even decreased. For a correct diagnosis, it is important for a doctor to be able to distinguish between primary and secondary hyperaldosteronism. This can be done based on the results of tests and tests, which we will discuss below.

Renin production by the kidneys is inhibited by the following factors:

increased aldosterone levels;
excess volume of circulating blood;
high blood pressure.

Normally, when a person gets up from a sitting or lying position, he produces renin, which quickly increases blood pressure. If there is an adrenal tumor that produces excess aldosterone, the release of renin is blocked. Therefore, orthostatic hypotension is possible - dizziness and even fainting with a sudden change in body position.

Let's list others possible symptoms primary hyperaldosteronism:

High blood pressure, can reach 200/120 mm Hg. Art.;
Excessive concentration of potassium in urine;
Low potassium levels in the blood, causing patients to feel weak;
Elevated levels of sodium in the blood;
Frequent urination, especially the urge to urinate in a horizontal position.

The symptoms observed in patients are common to many diseases. This means that it is difficult for a doctor to suspect primary hyperaldosteronism, and without testing it is generally impossible to make a diagnosis. Primary hyperaldosteronism should always be suspected if the patient has severe hypertension that is resistant to medication. Moreover, if the level of potassium in the blood turns out to be normal, this does not exclude that the production of aldosterone is increased.

Most meaningful analysis For diagnosis, it is necessary to determine the concentration of hormones of the renin-aldosterone system in the blood. In order for the test results to be reliable, the patient needs to carefully prepare for their delivery. Moreover, preparations begin very early, 14 days in advance. It is advisable at this time to stop taking all blood pressure pills, balance your diet, and protect yourself from stress. During the preparatory period, it is better for the patient to go to the hospital.

What blood tests are done:

Aldosterone;
Potassium;
Plasma renin activity;
Activity and concentration of renin before and after taking 40 mg of furosemide.

It is advisable to take a blood test for aldosterone early in the morning. At night, the level of aldosterone in the blood should decrease. If the concentration of aldosterone in the morning blood is increased, then this more clearly indicates a problem than if the test is taken in the afternoon or evening.

Of particular diagnostic importance is the calculation of the ratio of aldosterone content (ng/ml) and plasma renin activity (ng/(ml*h)). The normal value of this ratio is below 20, the diagnostic threshold is above 30, and if it is more than 50, then the patient almost certainly has primary hyperaldosteronism. The calculation of this ratio has been widely implemented in clinical practice only recently. As a result, it turned out that every tenth patient with hypertension suffers from primary hyperaldosteronism. However, the level of potassium in the blood may be normal and decrease only after a salt load test is carried out for several days.

If the results of the blood tests listed above do not allow an unambiguous diagnosis, then additional salt or captopril load tests are performed. Salt loading is when the patient eats 6-9 g of table salt per day. This increases the exchange of potassium and sodium in the kidneys and allows you to clarify the results of tests for aldosterone levels in the blood. If hyperaldosteronism is secondary, then salt loading will inhibit aldosterone production, but if it is primary, then not. Test with 25 mg captopril - the same. If a patient has hypertension due to kidney problems or other reasons, captopril will lower the level of aldosterone in the blood. If the cause of hypertension is primary hyperaldosteronism, then while taking captopril, the level of aldosterone in the blood will remain unchanged.

They try to identify a tumor in the adrenal glands using ultrasound. But even if ultrasonography does not show anything, then the presence of adenoma or adrenal hyperplasia still cannot be completely excluded. Because in 20% of cases the tumor is less than 1 cm in size, and in this case it will not be easy to detect. Computed tomography or magnetic resonance imaging is always advisable if primary hyperaldosteronism is suspected. There is also a method for determining the concentration of aldosterone in blood from the adrenal veins. This method allows you to determine whether the problem is in one adrenal gland or both.

Blood pressure in patients with primary hyperaldosteronism can literally go through the roof. Therefore, they are especially susceptible to the serious complications of hypertension: heart attacks, strokes, and kidney failure. Also, low levels of potassium in the blood in many of them provokes the development of diabetes.

Above, at the beginning of the section devoted to this disease, we provided a table in which we showed that the choice of surgical or drug treatment for primary hyperaldosteronism depends on its cause. The physician must make the correct diagnosis to distinguish unilateral aldosterone-producing adenoma from bilateral adrenal hyperplasia. The latter is considered a milder disease, although it is less amenable to surgical treatment. If the damage to the adrenal glands is bilateral, then surgery can normalize blood pressure in less than 20% of patients.

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If an operation is planned, then before it the aldosterone content in the blood that flows from the adrenal veins should be determined. Let's say a tumor of the adrenal gland is discovered as a result of an ultrasound, computer or magnetic resonance imaging. But according to the results of a blood test, it may turn out that it is not hormonally active. In this case, it is recommended to refrain from performing the operation. Hormonally inactive tumors of the adrenal cortex are found at any age in 0.5-10% of people. They don't cause any problems and you don't need to do anything with them.

Patients with primary hyperaldosteronism are prescribed spironolactone, a specific aldosterone blocker, for hypertension. Potassium-sparing diuretics are also used - amiloride, triamterene. Spironolactone is started immediately with high doses, 200-400 mg per day. If it is possible to stabilize blood pressure and normalize the level of potassium in the blood, then the dose of this drug can be significantly reduced. If the level of potassium in the blood is consistently normal, then thiazide diuretics are also prescribed in small doses.

If blood pressure control remains poor, the medications listed above are supplemented with long-acting dihydropyridine calcium antagonists. These drugs are nifedipine or amlodipine. Many practitioners believe that ACE inhibitors help well with bilateral adrenal hyperplasia. If the patient experiences side effects or intolerance to spironolacter, then eplerenone should be considered, this is a relatively new drug.

First let's introduce the terminology:

Cortisol is one of the hormones produced in the adrenal glands.
The pituitary gland is a gland in the brain that produces hormones that affect growth, metabolism and reproductive function.
Adrenocorticotropic hormone (adrenocorticotropin) - produced in the pituitary gland, controls the synthesis of cortisol.
The hypothalamus is one of the parts of the brain. Stimulates or inhibits the production of hormones by the pituitary gland and thus controls the human endocrine system.
Corticotropin-releasing hormone, also known as corticorelin, corticotropin-releasing hormone, is produced in the hypothalamus, acts on the anterior pituitary gland and causes the secretion of adrenocorticotropic hormone there.
Ectopic - one that is located in unusual place. Excessive production of cortisone is often stimulated by tumors that produce adrenocorticotropic hormone. If such a tumor is called ectopic, it means that it is not in the pituitary gland, but somewhere else, for example, in the lungs or in the thymus gland.

Itsenko-Cushing syndrome, also known as hypercortisolism, is a disease in which too much of the hormone cortisol is produced. Hypertension occurs in approximately 80% of patients with this hormonal disorder. Moreover, blood pressure is usually significantly increased, from 200/120 mm Hg. Art., and it cannot be normalized by any traditional medicines.

The synthesis of cortisol in the human body is controlled by a complex chain of reactions:

First, corticotropin-releasing hormone is produced in the hypothalamus.
It acts on the pituitary gland to produce adrenocorticotropic hormone.
Adrenocorticotropic hormone gives a signal to the adrenal glands to synthesize cortisol.

Itsenko-Cushing syndrome can be caused by the following reasons:

Due to problems with the pituitary gland, too much adrenocorticotropic hormone circulates in the blood, which stimulates the adrenal glands.
A tumor develops in one of the adrenal glands, while the levels of adrenocorticotropic hormone in the blood are normal.
An ectopic tumor that is not located in the pituitary gland and produces adrenocorticotropic hormone.
There are also rare causes, which are listed in the table below along with the main ones.

In approximately 65-80% of patients, excess cortisol production occurs due to increased secretion of adrenocorticotropic hormone. In this case, a secondary enlargement (hyperplasia) of the adrenal glands is observed. This is called Cushing's disease. In almost 20% of cases primary cause is a tumor of the adrenal glands, and it is not called a disease, but Cushing's syndrome. More often there is a unilateral tumor of the adrenal glands - adenoma or carcinoma. Bilateral adrenal tumor is rare and is called micro- or macronodular hyperplasia. Cases of bilateral adenoma have also been described.

Classification of causes of hypercortisolism

Spontaneous hypercortisolism
Cushing's disease (pituitary hypercortisolism)
Ectopic production of adrenocorticotropic hormone
Ectopic production of corticotropin-releasing hormone	Very rarely
Cushing's syndrome (adrenal hypercortisolism)
Adrenal carcinoma
Adrenal hyperplasia
Hereditary forms (Carney, McClury-Albright syndromes)
Iatrogenic hypercortisolism
Taking adrenocorticotropic hormone
Taking glucocorticoids	Most often
Pseudo-Cushing's syndrome (alcoholism, depression, HIV infection)

Cushing's syndrome is more common in women, usually between the ages of 20 and 40. In 75-80% of patients, it is difficult to detect the location of the tumor, even with the use of modern methods of computed tomography and magnetic resonance imaging. Nevertheless, primary diagnosis The disease does not present any difficulties, because chronic elevated levels of cortisol in the blood cause typical changes in the appearance of patients. This is called Cushingoid type of obesity. Patients have a moon-like face, purplish-blue cheeks, and fat deposits in the neck, torso, shoulders, abdomen and thighs. At the same time, the limbs remain thin.

Additional symptoms of elevated cortisol levels in the blood:

Osteoporosis and brittle bones.
Low potassium concentration in the blood.
Tendency to bruise.
Sick people lose muscle mass, look weak, stoop.
Apathy, drowsiness, loss of intelligence.
The psycho-emotional state often changes from irritability to deep depression.
Skin stretch marks on the abdomen, purple in color, 15-20 cm long.

Symptoms of increased levels of adrenocorticotropic hormone in the blood and pituitary tumors:

Headaches caused by a tumor of the pituitary gland, which presses from the inside.
Body skin pigmentation.
In women - menstrual irregularities, atrophy of the mammary glands, growth of unwanted hair.
In men - potency disorders, testicular hypotrophy, beard growth decreases.

First of all, they try to determine the increased level of cortisol in the blood or daily urine. At the same time, a one-time negative test result does not prove the absence of the disease, because the level of this hormone physiologically fluctuates within a wide range. It is recommended to measure free cortisol in urine rather than 17-keto- and 17-hydroxyketosteroids. It is necessary to take measurements in at least two consecutive 24-hour urine samples.

It can sometimes be difficult to distinguish Cushing's syndrome from normal obesity, which often accompanies hypertension. To make a correct diagnosis, the patient is given the drug dexamethasone at a dose of 1 mg at night. If there is no Cushing's syndrome, then the level of cortisol in the blood will decrease the next morning, and if there is, then the level of cortisol in the blood will remain high. If a test with 1 mg of dexamethasone previously showed Cushing's syndrome, then a repeat test is performed using a larger dose of the drug.

The next stage is to measure the level of adrenocorticotropic hormone in the blood. If it turns out to be high, a pituitary tumor is suspected, and if it is low, then perhaps the primary cause is an adrenal tumor. It happens that adrenocorticotropic hormone is produced by a tumor not in the pituitary gland, but located somewhere else in the body. Such tumors are called ectopic. If the patient is given a dose of 2-8 mg of dexamethasone, the production of adrenocorticotropic hormone in the pituitary gland is suppressed, even despite the tumor. But if the tumor is ectopic, then dexamethasone in a high dosage will not affect its activity in any way, which will be evident from the results of a blood test.

To establish the cause of the disease - a pituitary tumor or an ectopic tumor - instead of dexamethasone, corticotropin-releasing hormone can also be used. It is administered in a dosage of 100 mcg. In Cushing's disease, this will lead to a decrease in the levels of adrenocorticotropic hormone and cortisol in the blood. And if the tumor is ectopic, then the hormone levels will not change.

Tumors that cause increased cortisol production are looked for using computed tomography and magnetic resonance imaging. If microadenomas with a diameter of 2 mm or more are found in the pituitary gland, then this is considered irrefutable evidence of the presence of Cushing's disease. If the tumor is ectopic, then it is recommended to carefully, step by step, “enlighten” the chest and abdominal cavity. Unfortunately, ectopic tumors can be very small in size and still produce hormones in large doses. For such cases, magnetic resonance imaging is considered the most sensitive examination method.

The cause of Cushing's syndrome is a tumor that produces “extra” hormone cortisol. Such a tumor may be located in the pituitary gland, adrenal glands, or somewhere else. The real method of treatment, which gives a long-term effect, is surgical removal of the problematic tumor, wherever it is located. Neurosurgery methods for removing pituitary tumors have undergone significant development in the 21st century. In the world's best clinics, the frequency full recovery after such operations is more than 80%. If the pituitary tumor cannot be removed in any way, then it is irradiated.

Varieties of Itsenko-Cushing syndrome

For six months after removal of the pituitary tumor, the patient’s cortisol level remains too low, so replacement therapy is prescribed. However, over time, the adrenal glands adapt and begin to function normally. If the pituitary gland cannot be cured, both adrenal glands are surgically removed. However, after this, the production of adrenocorticotropic hormone by the pituitary gland further increases. As a result, the patient’s skin color may darken significantly within 1-2 years. This is called Nelson's syndrome. If adrenocorticotropic hormone is produced by an ectopic tumor, then it is highly likely to be malignant. In this case, chemotherapy is necessary.

For hypercortisolism, the following medications can theoretically be used:

affecting the production of adrenocorticotropic hormone - cyproheptadine, bromocriptine, somatostatin;
inhibiting the production of glucocorticoids - ketoconazole, mitotane, aminoglutethimide, metyrapone;
blocking glucocorticoid receptors - mifepristone.

However, doctors know that these medications are of little use, and the main hope is surgical treatment.

Blood pressure in Cushing's syndrome is controlled with spironolactone, potassium-sparing diuretics, ACE inhibitors, and selective beta blockers. Try to avoid medications that negatively affect metabolism and reduce the level of electrolytes in the blood. Drug therapy hypertension in this case is only a temporary measure before radical surgery.

Acromegaly is a disease that is caused by excessive production of growth hormone. This hormone is also called somatotropic hormone, somatotropin, somatropin. The cause of the disease is almost always a tumor (adenoma) of the pituitary gland. If acromegaly begins before the end of the growth period in at a young age, then such people grow up to be giants. If it begins later, the following clinical signs appear:

coarsening of facial features, including massive lower jaw, developed brow ridges, prominent nose and ears;
disproportionately enlarged hands and feet;
There is also excessive sweating.

These signs are very characteristic, so any doctor can easily make a primary diagnosis. To determine the final diagnosis, you need to take blood tests for growth hormone, as well as insulin-like growth factor. The content of growth hormone in the blood in healthy people never exceeds 10 mcg/l, and in patients with acromegaly it exceeds. Moreover, it does not decrease even after taking 100 g of glucose. This is called a glucose suppression test.

Hypertension occurs in 25-50% of patients with acromegaly. Its cause is considered to be the property of growth hormone to retain sodium in the body. There is no direct relationship between blood pressure readings and the level of somatotropin in the blood. Patients with acromegaly often experience significant hypertrophy of the myocardium of the left ventricle of the heart. It is explained not so much by high blood pressure as by changes in hormonal levels. Because of it, the rate of cardiovascular complications among patients is extremely high. Mortality rate is about 100% within 15 years.

For acromegaly, conventional first-line blood pressure medications are prescribed, alone or in combination. Efforts are directed towards treating the underlying disease by surgically removing the pituitary tumor. After surgery, blood pressure in most patients decreases or completely normalizes. At the same time, the content of growth hormone in the blood decreases by 50-90%. The risk of death from all causes is also reduced several times.

There is research evidence that the use of bromocriptine can normalize the level of growth hormone in the blood in approximately 20% of patients with acromegaly. Also, short-term administration of octreotide, an analogue of somatostatin, suppresses the secretion of somatotropin. All of these measures can lower blood pressure, but the real long-term treatment is surgery or x-rays to the pituitary tumor.

Parathyroid glands (parathyroid glands, parathyroid glands) are four small glands located on the posterior surface of the thyroid gland, in pairs at its upper and lower poles. They produce parathyroid hormone (parathyroid hormone). This hormone inhibits the formation of bone tissue, leaches calcium from bones, and increases its concentration in the blood and urine. Hyperparathyroidism is a disease that occurs when too much parathyroid hormone is produced. The most common cause of the disease is hyperplasia (overgrowth) or tumor of the parathyroid gland.

Hyperparathyroidism leads to bone tissue being replaced by connective tissue in the bones, and calcium stones forming in the urinary tract. The doctor should suspect this disease if the patient has hypertension combined with elevated calcium levels in the blood. In general, arterial hypertension is observed in approximately 70% of patients primary hyperparathyroidism. Moreover, parathyroid hormone itself does not increase blood pressure. Hypertension occurs due to the fact that with a long course of the disease, kidney function is impaired, and the blood vessels lose the ability to relax. Parathyroid hypertensive factor is also produced - an additional hormone that activates the renin-angiotensin-aldosterone system and increases blood pressure.

Based on symptoms, without tests, it is impossible to immediately make a diagnosis. Manifestations from the bones - pain, fractures. From the kidneys - urolithiasis, renal failure, secondary pyelonephritis. Depending on which symptoms predominate, there are two forms of hyperparathyroidism - renal and bone. Tests show increased levels of calcium and phosphate in the urine, excess potassium and a lack of electrolytes in the blood. On x-rays signs of osteoporosis are noticeable.
Blood pressure increases already in the initial stages of hyperparathyroidism, and target organ damage develops especially quickly. Normal levels of parathyroid hormone in the blood are 10-70 pg/ml, and the upper limit increases with age. The diagnosis of hyperparathyroidism is considered confirmed if there is too much calcium in the blood and at the same time an excess of parathyroid hormone. Ultrasound and tomography of the parathyroid gland are also performed, and if necessary, a radiological contrast study.

Surgical treatment of hyperparathyroidism has been found to be safe and effective. After the operation, more than 90% of patients recover completely; blood pressure normalizes, according to various sources, in 20-100% of patients. Blood pressure pills for hyperparathyroidism are prescribed as usual - first-line medications alone or in combinations.

Hyperthyroidism is an increased production of thyroid hormones, and hypothyroidism is a lack of them. Both problems can cause drug-resistant hypertension. However, if the underlying disease is treated, then blood pressure will normalize.

A huge number of people have problems with the thyroid gland, especially often in women over 40 years of age. The main problem is that people with this problem do not want to go to an endocrinologist and take pills. If thyroid disease is left untreated, it greatly shortens life and worsens its quality.

The main symptoms of an overactive thyroid gland are:

thinness, despite a good appetite and good nutrition;
emotional instability, anxiety;
sweating, heat intolerance;
attacks of heartbeat (tachycardia);
symptoms of chronic heart failure;
skin warm and moist;
hair is thin and silky, early gray hair is possible;
The upper blood pressure is likely to be increased, while the lower blood pressure may be decreased.

The main symptoms of thyroid hormone deficiency are:

obesity, resistant to attempts to lose weight;
chilliness, cold intolerance;
puffy face;
swelling;
drowsiness, lethargy, memory loss;
hair is dull, brittle, falls out, grows slowly;
the skin is dry, the nails are thin and flaky.

You need to take blood tests:

Thyroid-stimulating hormone. If the function of the thyroid gland is reduced, then the content of this hormone in the blood is increased. And vice versa, if the concentration of this hormone is below normal, it means thyroid too active.
T3 free and T4 free. If the levels of these hormones are not normal, it means that the thyroid gland needs to be treated, even despite good numbers thyroid-stimulating hormone. Often there are hidden problems with the thyroid gland, in which the level of thyroid-stimulating hormone is normal. Such cases can only be detected using tests for free T3 and free T4.

Endocrine and cardiovascular changes in thyroid diseases

If the thyroid gland is too active, then hypertension occurs in 30% of patients, and if there is a deficiency of its hormones in the body, then the pressure is increased in 30-50% of such patients. Let's take a closer look.

Hyperthyroidism and thyrotoxicosis are the same disease, increased production of thyroid hormones, which accelerate metabolism. Cardiac output, pulse rate and myocardial contractility indicators increase. The volume of circulating blood increases, and peripheral vascular resistance decreases. The upper blood pressure is likely to be increased, while the lower blood pressure may be decreased. This is called systolic hypertension, or increased pulse pressure.

Let your endocrinologist prescribe therapy for hyperthyroidism. This is a broad topic that goes beyond the scope of the site about the treatment of hypertension. Beta blockers, both selective and non-selective, are considered the most effective as blood pressure pills. Some studies have shown that non-selective beta blockers may reduce excess production of the thyroid hormones T3 and T4. Non-dihydropyridine calcium antagonists, which slow the heart rate, may also be prescribed. If hypertrophy of the left ventricle of the heart is pronounced, then ACE inhibitors or angiotensin-II receptor blockers are prescribed. Diuretics complement the effects of all these drugs. It is undesirable to use dihydropyridine blockers calcium channels and alpha-blockers.

Hypothyroidism is a decreased production of thyroid hormones or problems with their availability to body tissues. This disease is also called myxedema. In such patients, cardiac output is reduced, pulse is reduced, circulating blood volume is also reduced, but peripheral vascular resistance is increased. Blood pressure increases in 30-50% of patients with hypothyroidism due to increased vascular resistance.

Tests show that those patients who have developed hypertension due to hypothyroidism have elevated levels of adrenaline and norepinephrine in the blood. Characterized by increased diastolic “lower” blood pressure. Upper blood pressure may not increase because the heart is working sluggishly. It is believed that the more elevated the lower pressure, the more severe the hypothyroidism, i.e., the more acute the lack of thyroid hormones.

Treatment of hypothyroidism - pills prescribed by an endocrinologist. When the therapy begins to work, your health improves and your blood pressure returns to normal in most cases. Get repeated blood tests for thyroid hormones every 3 months to adjust your pill dosage. In elderly patients, as well as those with a long history of hypertension, treatment is less effective. These categories of patients need to take blood pressure pills along with medications for hypothyroidism. ACE inhibitors, dihydropyridine calcium antagonists or alpha-blockers are usually prescribed. You can also add diuretics to enhance the effect.

We looked at the main endocrine causes, other than diabetes, that cause severe increases in blood pressure. It is typical that in such cases they do not help traditional methods treatment of hypertension. It is possible to stably bring blood pressure back to normal only after taking control of the underlying disease. In recent years, doctors have made progress in solving this problem. Particularly encouraging is the development of the laparoscopic approach to surgical operations. As a result, the risk for patients has decreased, and recovery after surgery has accelerated by approximately 2 times.

If you have hypertension + type 1 or type 2 diabetes, then read this article.

If a person has hypertension due to endocrine causes, then usually the condition is so bad that no one hesitates to see a doctor. An exception is problems with the thyroid gland - deficiency or excess of its hormones. Tens of millions of Russian-speaking people suffer from thyroid diseases, but are lazy or stubbornly do not want to be treated. They do themselves a disservice: they shorten their own lives, suffer because severe symptoms, are at risk of having a sudden heart attack or stroke. If you have symptoms of hyper- or hypothyroidism, get blood tests and go to an endocrinologist. Don't be afraid to take thyroid hormone replacement pills, they provide significant benefits.

The rarest endocrine causes of hypertension are beyond the scope of the article:

hereditary diseases;
primary hyperrenism;
endothelin-producing tumors.

The likelihood of these diseases is much lower than that of a lightning strike. If you have questions, please ask them in the comments to the article.

The hormone renin is a substance that affects the water-salt balance in the human body. With its participation, blood pressure normalizes. It is one of the links in a complex hormonal chain - renin-angiotensin-aldosterone. If there is a failure in this system, the consequences for the human body can be very serious.

Functional tasks of renin

Renin - what is it? Renin is a peptide hormone that is synthesized during complex biochemical processes. It has a great influence on the functioning of the adrenal cortex, thereby stimulating the intensive production of hormonal elements such as and. An increase or decrease in the level of this substance leads to problems with blood pressure.

How is the substance produced?

Where is renin produced? This substance is produced by the adrenal glands. Its synthesis occurs under the influence of complex biochemical processes.

The juxtaglomerular apparatus consists of special renal cells. It is located in the area of arterioles, which, in turn, are located in the glomeruli of the kidneys. It is here that prorenin is produced, which, under the influence of blood cells, is transformed into renin.

What is the hormone renin responsible for?

First of all, it regulates blood pressure, helping to increase it. Active secretion of the hormone occurs in situations where:

the person suffered severe stress;
there is a decrease in blood circulating in the vessels;
blood supply to the kidneys deteriorates;
the patient suffers from hypotension;
the patient suffers from hypokalemia or sodium deficiency in the blood.

In addition to regulating blood pressure, renin promotes the breakdown of protein secreted by liver cells. This also affects blood pressure levels, since when it increases, the adrenal cortex secretes aldosterone more intensely.

Clinical study on renin

What renin indicators can be considered normal, and on what factors does the level of the hormonal element depend? First of all, the performance of this substance is affected by the body position in which the person is located during the collection of biomaterial. But there is another factor that must be taken into account: the amount of salt consumed by the patient. For each of these situations, the amount of hormone is calculated differently.

Note. The level of renin in the blood does not differ between men and women. However, if the patient is pregnant, her hormone levels may be slightly different.

Norms in lying and standing positions

So, the norm of renin in the blood in women and men can be as follows:

Sitting or standing position (with habitual salt consumption) – from 0.7 to 3.3 ng/ml/h.
Lying position (with normal salt intake) – from 0.32 to 1.6 ng/ml/h.

In adults in sitting position while following a low-salt diet normal indicators numbers from 4.2 to 19.8 ng/ml/h are considered. In the supine position - t 0.4 to 3.2.

Indicators in pregnant women

Renin in women during pregnancy can deviate significantly from the norm. As a rule, such changes occur in the first trimester, when the volume of circulating blood in the expectant mother’s body increases significantly. As a result, renin levels can increase by 2 times. But by 20 weeks this disorder disappears.

Aldosterone-renin ratio

The normal aldosterone-renin ratio (ARR) is 3.8 to 7.7, respectively. This study is a screening marker for primary hyperaldosteronism.

Appointment for analysis

Increased and decreased renin are equally dangerous phenomena that require mandatory medical intervention. Clinical examination of blood plasma can help identify deviations from the norm. It requires careful preparation, which should begin 3-4 weeks before the scheduled test date.

So, you can prepare for a renin test as follows:

Exclude salty and smoked dishes from the menu. A few days before the test, the doctor may suggest that the patient follow a low-salt diet.
Stop taking hormone-containing medications, as well as medications that may affect the reliability of the results.
Avoid using products containing caffeine - with their regular use, renin is significantly increased in almost all patients. Therefore, the results will be unreliable.

In addition to this, you need to do a few more simple rules. You must stop taking diuretics 24 hours before the test. hormonal contraceptives, ACE inhibitors, lithium, etc. You should avoid dinner before the test, and the day before, you should avoid drinking alcohol and smoking.

Causes of increased renin

The reasons that renin is elevated are often related to:

tumor neoplasms affecting the production of hormonal substances;
acute glomerulonephritis;
malignant nature of hypertension;
polycystic neoplasms in renal tissues;
development of Addison's disease.

Also, causes of increased renin in the blood can be nephrotic syndrome or a condition preceding it, and cirrhosis of the liver.

Aldosterone-renin ratio imbalance

If during clinical trial It was found that the aldosterone-renin ratio was increased, this is evidence of the development of primary hyperaldosteronism. This condition, in turn, can be caused by a number of pathological processes, so it is impossible to make a final diagnosis based on biochemical analysis alone. To do this, you should perform an ultrasound of the kidneys and adrenal glands, MRI, CT, and, if necessary, a biopsy or scintigraphy.

If aldosterone is elevated, but renin levels remain normal, then such a deviation may indicate a dysfunction of the adrenal cortex. In any case, all deviations in the higher direction are not the norm, especially if, in addition to hormones, sodium in the blood was also affected.

Thus, low renin with normal aldosterone is not always considered as a signal that there are any pathological processes. Again, only if sodium and potassium levels are within normal limits. If their content is also reduced, the doctor prescribes additional instrumental methods diagnostics to determine the causes of deviation.

The reasons for increased renin in the blood, as can be seen, can be very different. But since ARS plays a huge role in diagnosing diseases of the endocrine system, based on the results laboratory research It is not practical to make a diagnosis to identify one specific substance from a given chain.

The main thing to remember is that high renin is more dangerous than low renin, and the same goes for the hormone aldosterone.

Conn's syndrome, primary and secondary hyperaldosteronism, narrowing (stenosis) of the renal arteries are only the smallest part of the diseases in which the ratio of these substances can be disrupted. Therefore, do not hesitate to visit a doctor if you detect alarming symptoms: hypotonicity of muscles, emotional instability, fatigue, decreased vision and pressure surges. Timely treatment increases the chances of a full recovery!

Renin is an important component that affects the functioning of our body. Thanks to its functioning, the body controls blood pressure levels and also regulates the volume of circulating blood.

Many people call the renin valve, the operating pattern of which can be described as the functioning of a watering rod: if you reduce the diameter of the duct, the flow force becomes much greater. However, the jet itself becomes smaller. Renin is secreted by the kidneys, which means renal component in Latin.

The juxtaglomerular apparatus - special cells of the kidneys - is located in the arterioles, which are located in the renal glomerulus. Thanks to these cells, prorenin is released into the body.

What triggers the production of renin:

Stressful conditions;
Reduced amount of blood that circulates throughout the body;
Decreased blood supply to the renal ducts;
Low levels of potassium or sodium in the blood;
Low blood pressure.

In addition, the hormone renin-angiotensin, doctors call it aldosterone-renin, can change the functioning of the blood system. It is also called hormone ratio.

High levels of the hormone renin

An increased level of renin in human blood is more dangerous than a decreased one - it poses a high risk of serious complications and the appearance of chronic pathologies. The appearance of the latter, due to a reduced level of renin, affects the functioning of internal organs; the cardiovascular system, as well as the kidneys, suffer the most due to this disorder.

No one can be surprised by the constantly fluctuating pressure - life in a metropolis changes. In addition, it is affected by the frequency of drinking alcoholic beverages, the level of physical activity, and stressful situations.

In addition, in a person who suffers from arterial hypertension, an increase in blood pressure due to certain factors leads to death or serious complications.

Age-related changes in blood pressure

70% of people over the age of 45 have cardiovascular diseases of various stages. This statistics is due to age-related changes in the body - blood vessels narrow and blood pressure levels rise.

At the same time, the volume of renin that is present in the body cannot perform its direct functions. If the pressure level drops even a little, the body begins to secrete renin - the already high pressure begins to rise.

Increased blood pressure due to renin

It is worth noting that due to the increase in the speed of blood flow in the body, the membrane membrane experiences great stress - if treatment is not started in time, it cannot withstand the constant pressure and ruptures.

Congestive heart failure

The appearance of muscle weakness;
The mucous membranes of the entire body become inflamed;
Severe shortness of breath appears even with light exertion;
Tachycardia or arrhythmia appears;
Due to fluid retention, numerous swelling occurs.

Without comprehensive treatment of the pathology, it progresses and causes numerous lesions of the kidneys and adrenal cortex, in addition, the condition of the liver is disturbed: it becomes larger, thickens, and serious pain occurs on palpation. If the renin level is not brought back to normal in time, there is a high probability of severe diseases of many organs and systems. An increase in renin provokes the production of bilirubin, which in large quantities leads to non-alcoholic cirrhosis.

are resistant because they undergo hydrolysis followed by precipitation of hydroxides. The forms of iron migration in soil and groundwater change seasonally: during the spring flood period, with a large amount of suspended material, suspended forms predominate; during low water (seasonal decrease in water level in rivers), organic matter plays a large role in the transfer of iron. The most important sources of chemicals, including nutrients, into natural waters are divided into two large groups: external and internal. External sources provide the supply of substances to water bodies with river runoff, precipitation, industrial, domestic and agricultural wastewater. Internal sources accumulate chemical elements due to the processes of entry from the flooded bed of reservoirs, mineralization of woody, meadow and higher aquatic vegetation and dead plankton, as well as bottom sediments.

4. Organic substances in natural waters

Organic substances are one of the most complex groups of compounds contained in natural waters in terms of their qualitative composition. It includes organic acids, phenols, humic substances, nitrogen-containing compounds, carbohydrates, etc., which accumulate due to intra-reservoir processes (autochthonous).

Natural waters contain organic substances in relatively low concentrations. Average concentration organic carbon in river and lake waters rarely exceeds 20 mg/l. In sea and ocean waters the C content is even lower. The content of protein-like substances, free amino acids and amines ranges from 20–340, 2–25 and 6–200 μg of nitrogen per 1 liter, respectively.

Allochthonous (coming from the outside) include organic acids, esters, carbohydrates, and humic substances. The concentration of organic acids and esters rarely exceeds the limits of 40–200 and 50–100 µg/l. The carbohydrate content is slightly higher and often reaches a few milligrams per liter. A significant part of the organic matter of natural waters consists of humic substances: humic acids and fulvic acids. The waters of the northern regions of the country are especially rich in humic substances, where their concentration is often a few and tens of milligrams per 1 liter. In sea and ocean waters, the average content of humic substances is lower and rarely exceeds 3 mg/l.

Based on their origin, organic substances in natural waters are divided into two large groups:

1) products of biochemical decomposition of the remains of organisms inhabiting the reservoir (mainly plankton) are substances of autochthonous origin;

2) organic substances entering reservoirs from the outside with river runoff, precipitation, industrial, household and agricultural wastewater - allochthonous substances. A special place in this group is occupied by humic substances in soils, peat bogs, and forest litter.

Organic substances in natural waters can be in the state of true solutions, colloids and suspended coarse particles (suspensions). The colloidal form of migration is most typical for natural waters of the hypergenesis zone, rich in high-molecular humic substances. However, some of the colored organic compounds - fulvic acids and some forms of humic acids - may be in a state of true solutions. Natural waters are characterized by the migration of organic matter in the form of suspensions, for example, detritus, consisting of tiny organic and inorganic residues formed during the decay of dead organisms. Complexation occupies a special place among these phenomena, which has a positive effect. biological significance, inactivating excess amounts of heavy metal ions; favors the dissolution of hard-to-reach but biologically important elements.

In natural waters, chemical elements are found in the form of a number of inorganic and various organic compounds. In a dissolved state

The chemical composition of fresh water is dominated by four metals present in the form of simple cations (Ca2+, Na+, K+, Mg2+).

The quantitative and qualitative content of the main anions and cations determines whether it belongs to a particular class of water. However mineral composition water is not the only factor determining water quality.

Organic substances are one of the most complex groups of compounds found in natural waters in terms of their qualitative composition; they include organic acids, phenols, humic substances, nitrogen-containing compounds, and carbohydrates. Organic substances in natural waters can be in the state of true solutions, colloids and suspended coarse particles (suspensions).

When forming the chemical composition of natural waters, direct and indirect, as well as major and minor factors are distinguished. The main factors determine the content of the main anions and cations (i.e., the class and type of water according to the classification of O. A. Alekin). Secondary factors cause the appearance of some features of this water (color, smell, etc.), but do not affect

its class and type.

Control questions

1. Which ions are the main ones, regardless of the origin of water?

2. What organic substances are most often found in rivers and lakes?

3. What is the peculiarity of the classification of waters according to O. A. Alekin?

4. What waters belong to the class of ultra-fresh?

5. What waters are classified as brines?

Organic carbon

Organic carbon is the most reliable indicator of the total content of organic substances in natural waters; on average, it accounts for about 50% of the mass of organic substances.

The composition and content of organic substances in natural waters is determined by a combination of many processes that are different in nature and speed: post-mortem and intravital secretions of aquatic organisms; inputs with precipitation, with surface runoff as a result of the interaction of atmospheric waters with soils and vegetation on the surface of the catchment area; receipts from other water bodies, from swamps, peat bogs; receipts from domestic and industrial wastewater.

The concentration of organic carbon is subject to seasonal fluctuations, the nature of which is determined by the hydrological regime of water bodies and associated seasonal variations in chemical composition, and temporary changes in the intensity of biological processes. In the bottom layers of reservoirs and the surface film, the content of organic carbon can differ significantly from its content in the rest of the water.

Organic substances are found in water in dissolved, colloidal and suspended states, forming a certain dynamic system, generally nonequilibrium, in which, under the influence of physical, chemical and biological factors, transitions from one state to another are continuously carried out.

Hydrocarbons (petroleum products)

Petroleum products are among the most common and dangerous substances that pollute surface waters. Oil and its products are an extremely complex, unstable and diverse mixture of substances (low- and high-molecular saturated, unsaturated aliphatic, naphthenic, aromatic hydrocarbons, oxygen, nitrogen, sulfur compounds, as well as unsaturated heterocyclic compounds such as resins, asphaltenes, anhydrides, asphaltene acids). The concept of “petroleum products” in hydrochemistry is conventionally limited only to the hydrocarbon fraction (aliphatic, aromatic, alicyclic hydrocarbons).

Large quantities of petroleum products enter surface waters when transporting oil by water, with wastewater from oil production, oil refining, chemical, metallurgical and other industries, and with domestic waters. Some amounts of hydrocarbons enter water as a result of intravital secretions by plant and animal organisms, as well as as a result of their postmortem decomposition.

As a result of the processes of evaporation, sorption, biochemical and chemical oxidation occurring in a reservoir, the concentration of petroleum products can be significantly reduced, while their chemical composition may undergo significant changes. Aromatic hydrocarbons are the most stable, n-alkanes the least.

Petroleum products are found in various migration forms: dissolved, emulsified, sorbed on solid particles of suspensions and bottom sediments, in the form of a film on the surface of the water. Usually, at the moment of entry, the mass of petroleum products is concentrated in the film. As one moves away from the source of pollution, a redistribution occurs between the main forms of migration, directed toward increasing the proportion of dissolved, emulsified, and sorbed petroleum products. The quantitative ratio of these forms is determined by a complex of factors, the most important of which are the conditions for the entry of petroleum products into a water body, the distance from the place of discharge, the speed of flow and mixing of water masses, the nature and degree of pollution of natural waters, as well as the composition of petroleum products, their viscosity, solubility, density, boiling point of components. During sanitary-chemical control, as a rule, the amount of dissolved, emulsified and sorbed forms of oil is determined.

The adverse effects of petroleum products affect different ways on the human body, fauna, aquatic vegetation, physical, chemical and biological state of the reservoir. Low molecular weight aliphatic, naphthenic and especially aromatic hydrocarbons contained in petroleum products have a toxic and, to some extent, narcotic effect on the body, affecting the cardiovascular and nervous systems. Greatest danger are polycyclic condensed hydrocarbons such as 3,4-benzapyrene, which have carcinogenic properties. Petroleum products envelop the plumage of birds, the body surface and organs of other aquatic organisms, causing disease and death.

The negative influence of petroleum products, especially in concentrations of 0.001-10 mg/dm3, and their presence in the form of a film also affects the development of higher aquatic vegetation and microphytes.

In the presence of petroleum products, water acquires a specific taste and smell, its color and pH change, and gas exchange with the atmosphere worsens.

Methane

Methane belongs to gases of biochemical origin. The main source of its formation are dispersed organic substances in rocks. In its pure form, it is sometimes present in swamps, formed during the rotting of swamp vegetation. This gas in natural waters is in a molecularly dispersed state and does not enter into chemical interaction with water.

Benzene

Benzene is colorless liquid with a characteristic odor.

Benzene enters surface waters from enterprises and production facilities of the main organic synthesis, petrochemical, chemical-pharmaceutical industry, plastics production, explosives, ion exchange resins, varnishes and paints, artificial leather, as well as wastewater from furniture factories. In the effluents of coke plants, benzene is contained in concentrations of 100-160 mg/dm3, in the wastewater of caprolactam production - 100 mg/dm3, and in the wastewater of isopropylbenzene production - up to 20,000 mg/dm3. The source of water pollution can be the transport fleet (used in motor fuel to increase the octane number). Benzene is also used as a surfactant.

Benzene quickly evaporates from water bodies into the atmosphere (half-life is 37.3 minutes at 20°C). The threshold for smelling benzene in water is 0.5 mg/dm3 at 20°C. At 2.9 mg/dm3 the odor is characterized by an intensity of 1 point, at 7.5 mg/dm3 - by 2 points. Fish meat acquires an unpleasant odor at a concentration of 10 mg/dm3. At 5 mg/dm3 the odor disappears within a day, at 10 mg/dm3 the intensity of the odor per day is reduced to 1 point, and at 25 mg/dm3 the odor is reduced to 1 point after two days.

The taste at a benzene content in water of 1.2 mg/dm3 is measured as 1 point, at 2.5 mg/dm3 - as 2 points. The presence of benzene in water (up to 5 mg/dm3) does not change the processes of biological oxygen consumption, since benzene is weakly oxidized under the influence of biochemical processes in water. At concentrations of 5-25 mg/dm3, benzene does not delay the mineralization of organic substances and does not affect the processes of bacterial self-purification of water bodies.

At a concentration of 1000 mg/dm3, benzene inhibits the self-purification of diluted wastewater, and at a concentration of 100 mg/dm3, it inhibits the process of wastewater treatment in aeration tanks. At a content of 885 mg/dm3, benzene greatly retards the fermentation of sludge in digesters.

With repeated exposure to low concentrations of benzene, changes are observed in the blood and hematopoietic organs, damage to the central and peripheral nervous system, gastrointestinal tract. Benzene is classified as a highly suspected carcinogen. The main metabolite of benzene is phenol. Benzene has a toxic effect on aquatic organisms.

Phenols

Phenols are benzene derivatives with one or more hydroxyl groups. They are usually divided into two groups - phenols that are volatile with steam (phenol, cresols, xylenols, guaiacol, thymol) and non-volatile phenols (resorcinol, pyrocatechol, hydroquinone, pyrogallol and other polyhydric phenols).

Phenols under natural conditions are formed in the metabolic processes of aquatic organisms, during the biochemical decomposition and transformation of organic substances occurring both in the water column and in bottom sediments.

Phenols are one of the most common pollutants entering surface waters with wastewater from oil refining, shale processing, timber chemical, coke chemical, aniline paint industries, etc. In the wastewater of these enterprises, the content of phenols can exceed 10-20 g/dm3 in very diverse combinations.

In surface waters, phenols can be dissolved in the form of phenolates, phenolate ions and free phenols. Phenols in waters can enter into condensation and polymerization reactions, forming complex humus-like and other fairly stable compounds. Under the conditions of natural reservoirs, the processes of adsorption of phenols by bottom sediments and suspensions play a minor role.

Exceeding the natural background level for phenol may indicate pollution of water bodies. In natural waters contaminated with phenols, their content can reach tens and even hundreds of micrograms per 1 dm3. Phenols are unstable compounds and are subject to biochemical and chemical oxidation.

Simple phenols are susceptible mainly to biochemical oxidation. At a concentration of more than 1 mg/dm3, the destruction of phenols occurs quite quickly, the loss of phenols is 50-75% in three days, at a concentration of several tens of micrograms per 1 dm3 this process slows down, and the loss over the same time is 10-15%. Phenol itself breaks down the fastest, cresols slowest, and xylenols even slower. Polyhydric phenols are destroyed mainly by chemical oxidation.

The concentration of phenols in surface waters is subject to seasonal changes. In summer, the content of phenols decreases (with increasing temperature, the rate of decomposition increases).

The discharge of phenolic waters into reservoirs and watercourses sharply worsens their general sanitary condition, affecting living organisms not only with its toxicity, but also with a significant change in the regime of nutrients and dissolved gases (oxygen, carbon dioxide).

As a result of chlorination of water containing phenols, stable compounds of chlorophenols are formed, the slightest traces of which (0.1 μg/dm3) give the water a characteristic taste.

In toxicological and organoleptic terms, phenols are unequal. Phenols volatile with steam are more toxic and have a more intense odor when chlorinated. The most pungent odors are produced by simple phenol and cresols.

Hydroquinone

Hydroquinone enters surface waters with wastewater from the production of plastics, film and photographic materials, dyes, and oil refining enterprises.

Hydroquinone is a strong reducing agent. Like phenol, it has a weak disinfectant effect. Hydroquinone does not impart odor to water; a taste appears at a concentration of several grams per 1 dm3; the threshold concentration for water color is 0.2 mg/dm3, for the effect on the sanitary regime of water bodies - 0.1 mg/dm3. Hydroquinone at a content of 100 mg/dm3 sterilizes water, at 10 mg/dm3 it inhibits the development of saprophytic microflora. At concentrations below 10 mg/dm3, hydroquinone undergoes oxidation and stimulates the development of aquatic bacteria. At a concentration of 2 mg/dm3, hydroquinone inhibits the nitrification of diluted wastewater, 15 mg/dm3 - the process of their biological treatment. Daphnia die at 0.3 mg/dm3; 0.04 mg/dm3 causes the death of trout eggs.

In the body, hydroquinone is oxidized to p-benzoquinone, which converts hemoglobin into methemoglobin.

Alcohols Methanol

Methanol ends up in water bodies with wastewater from methanol production and use industries. Wastewater from pulp and paper industry enterprises contains 4.5-58 g/dm3 of methanol, phenol-formaldehyde resin production - 20-25 g/dm3, varnishes and paints 2 g/dm3, synthetic fibers and plastics - up to 600 mg/dm3, in wastewater from generating stations operating on brown coal, coal, peat, wood - up to 5 g/dm3.

When methanol enters water, it reduces the O2 content in it (due to the oxidation of methanol). Concentrations above 4 mg/dm3 affect the sanitary regime of water bodies. At a content of 200 mg/dm3, inhibition of biological wastewater treatment is observed. The odor threshold for methanol is 30-50 mg/dm3.

A concentration of 3 mg/dm3 stimulates the growth of blue-green algae and disrupts the oxygen consumption of daphnia. Lethal concentrations for fish are 0.25-17 g/dm3.

Methanol is strong poison, which has a targeted effect on the nervous and cardiovascular systems, optic nerves, and retina. The mechanism of action of methanol is associated with its metabolism according to the type of lethal synthesis with the formation of formaldehyde and formic acid, which are then oxidized to CO2. Visual impairment is caused by a decrease in ATP synthesis in the retina.

Ethylene glycol

Ethylene glycol enters surface waters with wastewater from industries where it is produced or used (textile, pharmaceutical, perfume, tobacco, pulp and paper industries).

The toxic concentration for fish is no more than 10 mg/dm3, for coli- 0.25 mg/dm3.

Ethylene glycol is very toxic. When ingested, it acts mainly on the central nervous system and kidneys, and also causes hemolysis of red blood cells. Metabolites of ethylene glycol - aldehydes and oxalic acid, which cause the formation and accumulation of calcium oxalates in the kidneys, are also toxic.

Organic acids

Organic acids are among the most common components of natural waters of various origins and often constitute a significant portion of the total organic matter in these waters. The composition of organic acids and their concentration are determined, on the one hand, by intra-reservoir processes associated with the vital activity of algae, bacteria and animal organisms, and on the other hand, by the supply of these substances from the outside.

Organic acids are formed due to the following intra-reservoir processes:

intravital secretions as a result of normal physiological processes of healthy cells;

post-mortem discharge associated with cell death and decay;

community secretions associated with the biochemical interaction of various organisms, such as algae and bacteria;

enzymatic decomposition of high molecular weight organic substances such as hydrocarbons, proteins and lipids.

The entry of organic acids into water bodies from the outside is possible with surface runoff, especially during high water and floods, with precipitation, industrial and domestic wastewater, and with water discharged from irrigated fields.

Volatile acids

Volatile acids mean the sum of the concentrations of formic and acetic acids.

Formic acid

In natural waters, formic acid is formed in small quantities during the processes of vital activity and post-mortem decomposition of aquatic organisms and the biochemical transformation of organic substances contained in water. Her increased concentration is associated with the entry into water bodies of wastewater from enterprises producing formaldehyde and plastics based on it.

Formic acid migrates mainly in a dissolved state, in the form of ions and undissociated molecules, the quantitative relationship between which is determined by the dissociation constant K25°C = 2.4.10-4 and pH values. When formic acid enters water bodies, it is destroyed mainly under the influence of biochemical processes.

Acetic acid Propionic acid

Propionic acid can enter natural waters with wastewater chemical industry.

Propionic acid can worsen the organoleptic properties of water, giving it an odor and a sourish-astringent taste. The most significant effect for propionic acid is on the sanitary regime of water bodies and, first of all, on the processes of BOD and oxygen regime. The complete biochemical oxidation of 1 mg of propionic acid requires 1.21 -1.25 mg of molecular oxygen.

Butyric acid Lactic acid

In natural waters, lactic acid is present in microgram concentrations as a result of the formation in the vital processes and post-mortem decomposition of aquatic organisms and the biochemical transformation of organic substances contained in water.

Lactic acid is found in water predominantly in a dissolved state in the form of ions and undissociated molecules, the quantitative ratio between which is determined by the dissociation constant K25°C = 3.10-4 and depends on the pH of the medium. Lactic acid partially migrates in the form of complex compounds with heavy metals.

The concentration of lactic acid is subject to noticeable seasonal changes, which is determined mainly by the intensity of biochemical processes occurring in water.

Benzoic acid

In unpolluted natural waters, benzoic acid is formed in small quantities during the life processes of aquatic organisms and their post-mortem decomposition. The main source of large quantities of benzoic acid entering water bodies is wastewater from industrial enterprises, since benzoic acid and its various derivatives are widely used in canning food products, in the perfume industry, for the synthesis of dyes, etc.

Benzoic acid is highly soluble in water, and its content in surface waters will be determined by the concentration of wastewater discharged and the rate of biochemical oxidation.

Benzoic acid has practically no toxic properties. Its unfavorable effect on the reservoir is associated with changes in the oxygen regime and pH of the water.

Humic acids

Humic and fulvic acids, collectively called humic acids, often make up a significant proportion of the organic matter of natural waters and are complex mixtures of biochemically stable high-molecular compounds.

The main source of humic acids entering natural waters are soils and peatlands, from which they are washed out by rain and swamp waters. A significant part of humic acids is introduced into water bodies along with dust and is formed directly in the water body during the transformation of “living organic matter”.

Humic acids in surface waters are in dissolved, suspended and colloidal states, the relationships between which are determined by the chemical composition of the water, pH, biological situation in the reservoir and other factors.

The presence of carboxyl and phenolhydroxyl groups and amino groups in the structure of fulvic and humic acids contributes to the formation of strong complex compounds of humic acids with metals. Some of the humic acids are in the form of slightly dissociated salts - humates and fulvates. In acidic waters, the existence of free forms of humic and fulvic acids is possible.

Humic acids significantly affect the organoleptic properties of water, creating an unpleasant taste and odor, making it difficult to disinfect and obtain especially pure water, and accelerating the corrosion of metals. They also influence the state and stability of the carbonate system, ionic and phase equilibria, and the distribution of migratory forms of microelements. An increased content of humic acids can have a negative impact on the development of aquatic plant and animal organisms as a result sharp decline the concentration of dissolved oxygen in the reservoir, which goes towards their oxidation, and their destructive effect on the stability of vitamins. At the same time, the decomposition of humic acids produces a significant amount of products valuable for aquatic organisms, and their organomineral complexes represent the most easily digestible form of plant nutrition with microelements.

Soil acids: humic acids (in an alkaline environment) and especially highly soluble fulvic acids play the greatest role in the migration of heavy metals.

Humic acids

Humic acids contain cyclic structures and various functional groups (hydroxyl, carbonyl, carboxyl, amino groups, etc.). Their molecular weight varies over a wide range (from 500 to 200,000 or more). Relative molecular mass conventionally assumed to be 1300-1500.

Fulvic acids

Fulvic acids are part of humic acids that do not precipitate during neutralization of organic substances extracted from peat and brown coal by treatment with alkali from solution. Fulvic acids are compounds of the hydroxycarboxylic acid type with a lower relative carbon content and more pronounced acidic properties.

Organic nitrogen

By “organic nitrogen” we mean nitrogen that is part of organic substances, such as proteins and proteids, polypeptides (high molecular weight compounds), amino acids, amines, amides, urea (low molecular weight compounds).

A significant portion of nitrogen-containing organic compounds enters natural waters during the death of organisms, mainly phytoplankton, and the disintegration of their cells. The concentration of these compounds is determined by the biomass of aquatic organisms and the rate of these processes. Another important source of nitrogen-containing organic substances is their intravital excretion aquatic organisms. Significant sources of nitrogen-containing compounds also include atmospheric precipitation, in which the concentration of nitrogen-containing organic substances is close to that observed in surface waters. A significant increase in the concentration of these compounds is often associated with the entry of industrial, agricultural and domestic wastewater into water bodies.

Urea

Urea (urea), being one of the important waste products of aquatic organisms, is present in natural waters in noticeable concentrations: up to 10-50% of the amount of nitrogen-containing organic compounds in terms of nitrogen. Significant amounts of urea enter water bodies with household wastewater, with collector waters, as well as with surface runoff in areas where it is used as a nitrogen fertilizer. Urea can accumulate in natural waters as a result of natural biochemical processes as a metabolic product of aquatic organisms, or be produced by plants, fungi, and bacteria as a product of the binding of ammonia formed during the dissimilation of proteins. Extraorganismal enzymatic processes have a significant impact on urea concentration. Under the action of enzymes, the mononucleotides of dead organisms decompose with the formation of purine and pyrimidine bases, which in turn decompose through microbiological processes to urea and ammonia. Under the action of a specific enzyme (urease), urea breaks down into ammonium ion and is consumed by aquatic plant organisms.

An increase in urea concentration may indicate contamination of a water body with agricultural and domestic wastewater. It is usually accompanied by an intensification of the processes of utilization of urea by aquatic organisms and the consumption of oxygen, leading to a deterioration in the oxygen regime.

Amines

The main sources of formation and entry of amines into natural waters include:

decarboxylation during the breakdown of protein substances under the influence of bacterial and fungal decarboxylases and amination;

seaweed;

precipitation;

wastewater from aniline dyeing plants.

Amines are present predominantly in a dissolved and partly in a sorbed state. With some metals they can form fairly stable complex compounds.

Amines are toxic. It is generally accepted that primary aliphatic amines are more toxic than secondary and tertiary amines, diamines are more toxic than monoamines; isomeric aliphatic amines are more toxic than aliphatic amines of normal structure; monoamines are more likely to be hepatotoxic, and diamines are more likely to be nephrotoxic. Among aliphatic amines, unsaturated amines are characterized by the greatest toxicity and potential danger due to their most pronounced ability to inhibit the activity of amine oxidases.

Amines, present in water bodies, negatively affect the organoleptic properties of water and can aggravate the phenomena of death.

Aniline

Aniline is an aromatic amine and is a colorless liquid with a characteristic odor.

Aniline can enter surface waters with wastewater from chemical (dyes and pesticides) and pharmaceutical plants.

Aniline has the ability to oxidize hemoglobin into methemoglobin. Urotropin

Hexamethylenetetramine - (CH2)6N4

Nitrobenzene

Nitrobenzene is a colorless or greenish-yellow oily liquid with the odor of bitter almonds.

Nitrobenzene is toxic, penetrates the skin, has a strong effect on the central nervous system, disrupts metabolism, causes liver disease, and oxidizes hemoglobin into methemoglobin.

Organic sulfur Methyl mercaptan

Methyl mercaptan is a metabolic product of living cells. It also comes with wastewater from pulp industry enterprises (0.05 - 0.08 mg/dm3).

In an aqueous solution, methyl mercaptan is a weak acid and partially dissociates (the degree of dissociation depends on the pH of the medium). At pH 10.5, 50% of methyl mercaptan is in ionic form; at pH 13, complete dissociation occurs. Methyl mercaptan is stable for less than 12 hours and forms salts - mercaptides.

Dimethyl sulfide

Dimethyl sulfide is released by algae (Oedogonium, Ulothrix) during normal physiological processes that are essential in the sulfur cycle. Dimethyl sulfide can also enter surface waters with wastewater from pulp industry enterprises (0.05 - 0.08 mg/dm3).

Dimethyl sulfide cannot be stored in water for a long time (stable from 3 to 15 days). It partially undergoes transformations with the participation of algae and microorganisms, and mainly evaporates into the air.

At concentrations of 1-10 μg/dm3, dimethyl sulfide has weak mutagenic activity.

Dimethyl disulfide

Dimethyl disulfide is formed in the cells of various representatives of flora and fauna during the metabolism of organosulfur compounds, and can also be supplied with wastewater from pulp industry enterprises.

Carbonyl compounds

Carbonyl compounds include compounds containing carbonyl and carboxyl groups (aldehydes, ketones, keto acids, semi-functional carbonyl-containing substances).

In natural waters, carbonyl compounds can appear as a result of intravital secretions of algae, biochemical and photochemical oxidation of alcohols and organic acids, decomposition of organic substances such as lignin, and metabolism of bacteriobenthos. The constant presence of carbonyl compounds among the oxygen compounds of oil and in water in contact with hydrocarbon deposits allows us to consider the latter as one of the sources of enrichment of natural waters with these substances. Land plants are also a source of carbonyl compounds, in which aldehydes and ketones of the aliphatic series and furan derivatives are formed. A significant portion of aldehydes and ketones enter natural waters as a result of human activity.

The main factors causing a decrease in the concentration of carbonyl compounds are their ability to oxidize, volatility and the relatively high trophic value of certain groups of carbonyl-containing substances.

Acetone

Acetone enters natural waters with wastewater from pharmaceutical, wood-chemical industries, production of varnishes and paints, plastics, film, acetylene, acetaldehyde, acetic acid, plexiglass, phenol, acetone.

At concentrations of 40-70 mg/dm3, acetone gives water an odor, and 80 mg/dm3 - a taste. In water, acetone is not stable - at concentrations of 20 mg/dm3 it disappears on the seventh day.

Acetone has relatively low toxicity for aquatic organisms. Toxic concentrations for young daphnia are 8300, for adults - 12900 mg/dm3; at 9300 mg/dm3 daphnia die after 16 hours.

Acetone is a drug that affects all parts of the central nervous system. In addition, it has an embryotoxic effect.

Formaldehyde

Formaldehyde enters the aquatic environment with industrial and municipal wastewater. It is found in wastewater from the production of basic organic synthesis, plastics, varnishes, paints, medicines, leather, textile and pulp and paper industries.

The presence of formaldehyde has been recorded in rainwater in urban areas. Formaldehyde is a strong reducing agent. It condenses with amines and forms methenamine with ammonia. In an aquatic environment, formaldehyde undergoes biodegradation. Under aerobic conditions at 20°C, decomposition lasts about 30 hours, under anaerobic conditions - about 48 hours. Formaldehyde does not decompose in sterile water. Biodegradation in the aquatic environment is caused by the action of Pseudomonas, Flavobacterium, Mycobacterium, Zanthomonas.

The subthreshold concentration that does not affect the sanitary regime of water bodies and saprophytic microflora is 5 mg/dm3; the maximum concentration that does not cause disruption of biochemical processes during constant exposure for an arbitrarily long time is 5 mg/dm3, the maximum concentration that does not affect the operation of biological treatment facilities is 1000 mg/dm3.

BOD5 = 0.68 mg/dm3, BODtotal = 0.72 mg/dm3, COD = 1.07 mg/dm3. The smell is felt at 20 mg/dm3.

At 10 mg/dm3, formaldehyde has a toxic effect on the most sensitive fish species. At 0.24 mg/dm3, fish tissues acquire an unpleasant odor.

Formaldehyde has a general toxic effect, causing damage to the central nervous system, lungs, liver, kidneys, and organs of vision. Possible skin-resorptive effect. Formaldehyde has an irritating, allergenic, mutagenic, sensitizing, and carcinogenic effect.

Carbohydrates

Carbohydrates are a group of organic compounds that includes monosaccharides, their derivatives and condensation products - oligosaccharides and polysaccharides. Carbohydrates enter surface waters mainly as a result of processes of intravital release by aquatic organisms and their postmortem decomposition. Significant amounts of dissolved carbohydrates enter water bodies with surface runoff as a result of their leaching from soils, peat bogs, rocks, with precipitation, and with wastewater from yeast, brewing, sugar, pulp and paper and other factories.

In surface waters, carbohydrates are dissolved and suspended in the form of free reducing sugars (a mixture of mono, di- and trisaccharides) and complex carbohydrates.

Literature:

"Hydrochemical indicators of the state of the environment." Authors: T.V. Guseva, Y.P. Molchanova, E.A. Zaika, V.N. Vinichenko, E.M. Averochkin

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