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The components of our body - renin, angiotensin, aldosterone system - act as a valve that regulates blood volume and blood pressure level. The scheme of work of the renin looks the same as a trickle of water from the garden hose behaves when we water the beds. If we squeeze the tip of the hose with our fingers, then the stream of water becomes thinner, but beats with great pressure.

The hormones renin-angiotensin, 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 the blood vessels to contract and thereby increase blood pressure.

The group of hormones renin-angiotensin is synthesized by the adrenal cortex, therefore, all major violations of 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 associated with abnormal blood pressure levels.

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

An increased level of renin is a more serious hazard than a low level of the hormone. Pathologies associated with high renin have consequences in a wide variety of human organs, but the cardiovascular system and kidneys are most affected.

Hypertension. An insidious disease caused by persistent high blood pressure. This ailment, especially in youth, may not manifest itself in any way for many years, but surreptitiously slowly eat up the heart, liver and brain. If symptoms are still present, then it is usually dizziness, rapid pulse, ringing in the ears.

In everyday life, our pressure often "jumps", for example, during physical exertion, drinking alcohol or strong feelings. And if a person already suffers from hypertension, then such an additional increase in pressure can have serious consequences, up to and including death.

After 45 years, 70% of people have various degrees of this disease, due to age-related narrowing of the blood vessels. Unfortunately, renin does not know anything about this and continues to carefully and meticulously perform its function - as soon as the pressure drops slightly, the hormone, intensively secreting from the adrenal cortex, increases the already high pressure.

The risk of hypertension increases significantly if the patient or his immediate family has diabetes or obesity. These three diseases - obesity, diabetes mellitus 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 work of the urinary system, more precisely, that part of it, which is associated with blood purification. The kidneys consist of a huge number of 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 is carried out when blood passes through a thin membrane that adsorbs all harmful elements, and they are excreted into the bladder. What happens when renin raises blood pressure?

Our kidneys, working non-stop day and night, and so perform almost overwhelming work, passing through themselves up to 1500 liters of blood per day, and now, when the vessels are narrowing, the blood flow circulates even faster. In addition, high blood pressure increases the pressure on the membrane and when hypertension continues for many months, the membrane eventually breaks down and breaks.

This pathology of the nephrons of the kidney leads to sad consequences. A big risk now is the likelihood of toxic substances and proteins entering the bloodstream. The water-salt and potassium balance in the body is disturbed, inflammation of the kidneys 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 reason for the high pressure in this case is the same renin. At the initial stages of the disease, patients complain of:

severe shortness of breath even with little physical exertion,
muscle weakness
heart palpitations, arrhythmias, tachycardia,
inflammation of the mucous membranes of the eyes, genitals,
numerous edema 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 non-adherence to a diet that excludes fatty and spicy foods can lead to complete liver failure. Shortness of breath in patients is now already observed even at rest, and they can sleep only in a half-sitting position due to a feeling of lack of air.

The intestinal absorption function is impaired, causing diarrhea, up to and including persistent diarrhea. The swelling after sleep intensifies and does not go away, as before, by noon. Smoothly, the disease turns into the so-called cachexia, and if drug therapy fails, the patients die. This is how dangerous the hormone renin can be, when its level is significantly and for a long time increased in the human body without proper treatment.

Primary hyperaldosteronism. At the heart of the disease is an increased production of the hormone aldosterone by the adrenal cortex, caused by a low level of the renin-angiotensin group of hormones. It is rarely possible to diagnose the disease at the initial stage due to the absence of symptoms, with the exception of slight hypertension. Primary hyperaldosteronism can be caused by adrenal cancer and other neoplastic kidney diseases.

Under the influence of reduced renin, an excessive amount of sodium begins to linger and an excess amount of potassium is excreted. This leads to the accumulation of a large amount of water in the body, without the possibility of exiting through the urinary tract. The huge amount of fluid accumulated in the body immediately causes severe swelling in many parts of the body, increased fatigue and high blood pressure.

Renin is an important component that affects the functioning of our body. Thanks to its functioning, the blood pressure level in the body is controlled, as well as the volume of circulating blood is regulated.

Many people call a renin valve, the scheme of which can be described as the functioning of a sprinkler: if you reduce the diameter of the duct, the flow becomes much greater. However, the jet itself becomes smaller. Renin is excreted by the kidneys, in Latin it means the renal component.

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

It is converted into renin by the action of blood cells. 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;
Decrease in the amount of blood that circulates through the body;
Decreased blood supply to the renal ducts;
Low levels of potassium or sodium in your blood;
Low blood pressure.

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

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

It works as follows: as soon as the level of blood pressure rises, hormones are released - therefore, it begins to slowly decrease. Due to the ongoing biochemical reactions, the blood vessels of the body begin to constrict - thereby the level of blood pressure begins to rise.

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

In addition, a high or low level indicates an abnormal blood pressure level on an ongoing basis. In most cases, doctors send for analysis of the level of renin due to the detection of tumor formations of the adrenal cortex, detection of hypertensive ailments or renal failure.

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

- an insidious and dangerous disease that manifests itself as a constantly high level of blood pressure in humans. Its main danger is that in the early stages it does not manifest itself in any way - characteristic symptoms appear after hypertension becomes a serious ailment

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 heart rate, tinnitus, dizziness, and headache.

No one can be surprised by the ever-leaping pressure - life in a metropolis is changing the standards of health. In addition, it is influenced by the frequency of drinking alcohol, the level of physical activity, 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.

70% of people who have crossed the 45-year mark have diseases of the cardiovascular system of various stages. Such statistics are due to age-related changes in the body - the blood vessels narrow, the level of blood pressure rises.

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

If the next of kin are overweight and have high blood glucose levels, the risk of arterial hypertension increases significantly. All these ailments last after each other, complicating the course of the disease. The disease can be defeated only with an integrated approach to treatment.

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

Thanks to its work, it secretes and separates pathogenic and toxic elements from the blood - it makes the blood safe for the body. A thin membrane tube is responsible for everything - it purifies the blood, and harmful substances are transferred to the bladder.

The kidneys are an organ that is constantly working at full capacity. Thanks to them, more than 1.5 tons of blood fluid is filtered in the body in 24 hours. If the blood vessels are narrowed, the rate at which fluid circulates through the body is greatly increased.

It is worth noting that due to the increase in the blood flow rate in the body, the membrane membrane is under great stress - if treatment is started on time, it cannot withstand constant pressure and breaks.

Serious kidney damage of this nature sooner or later leads to sad consequences. The risk of toxic waste products being released into the blood is increasing. Because of this, violations of potassium and water-salt balance 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 the wrong action of the hormone renin. At the very beginning of the course of the disease, the patient notice the following changes in the body:

The appearance of muscle weakness;
The mucous membranes of the whole body become inflamed;
Severe shortness of breath appears even with mild exertion;
Tachycardia or arrhythmia appears;
Numerous edema occurs due to fluid retention.

Without complex 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, severe pain occurs on palpation. If the renin level is not brought back to normal in time, the likelihood of severe diseases of many organs and systems is high. An increase in renin provokes the production of bilirubin, which in large quantities leads to non-alcoholic cirrhosis.

Without proper treatment, taking even a small dose of alcohol with elevated renin levels can lead to complete liver failure. The picture is aggravated if a person consumes a large amount 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 on time, there is a high probability of death. Try to lead a healthy lifestyle, and then no ailment will ruin your mood.

If renin production is impaired in the body, 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. Cancer, mainly adrenal cancer, can cause a decrease in renin production.

Due to a decrease in the amount of renin in the human blood, the body cannot get rid of sodium and excretes excessive amounts of potassium. As a result, a large amount of fluid is retained in the body, and does not leave through the urinary tract. Large volumes of fluid can cause severe swelling and fatigue. In addition, the level of blood pressure rises sharply.

1 Factors causing hormone secretion

Reasons why renin is released:

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

All these processes take place in the kidneys, but other organs are involved 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 state is dormant and completely useless. The circulation of the substance occurs in the bloodstream, where it is inactive. 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, when it enters the vessel, forms angiotensin 2, a hormone that is considered to be very active. He takes part in the most important processes in the body, one of which is the increase in blood pressure. Also, the substance causes smooth muscles to contract, helping to increase resistance.

Angiotensin acts on kidney cells, causing the paired organ to reabsorb more water, resulting in increased blood volume. This contributes to an increase in 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 - to maintain a constant volume of circulating blood.

2 Why does the level of the hormone rise?

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

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

Reduced renin in the blood with an excessive amount of salt in the diet, increased release of antidiuretic hormone, acute renal failure, 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 can 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 of the medicines that the person took on the eve of the tests. Renin may decrease after taking Propranolol, Indomethacin, Reserpine, etc.

3 When do you need to get tested for a hormone?

Blood donation for hormonal research is carried out only if there are some indications: an increase in blood pressure, 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 obtain the correct indicators. If this is not done, the level of the substance can 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 must completely exclude the use of alcohol.
Blood for analysis is given on an empty stomach. At least 10 hours should pass from the last meal.
The day before the tests, it is necessary to stop taking certain medications, having previously consulted with a specialist.
On the eve of the test, any physical activity should be excluded (hard work, exercise in the gym). The emotional state 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 testing.

If a person is taking medications according to a scheme that cannot be interrupted, then you need to inform the doctor who will take the blood. The specialist will definitely record this and take it into account during the decoding of the indicators. If, according to the results of the study, renin is increased, most likely, additional studies and diagnostics of internal organs will be prescribed.

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

If the renin analysis indices deviate from the norm, the adrenal cortex is diagnosed, the liver is examined, etc. Further, treatment is prescribed in accordance with the established diagnosis. In case of violations in the work of the adrenal glands, the administration of drugs or the removal of glandular organs is indicated. In other cases, therapy is determined by the situation.

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

Outline of the article:

We first list the hormones that can cause problems, and you will find out what role they play in the body when everything is normal.
Then we will talk about specific diseases that are included in the list of endocrine causes of hypertension
And most importantly, we will give detailed information about the methods of their treatment.

I have done my best to explain complex medical problems in simple terms. Hopefully, this has more or less succeeded. Information on anatomy and physiology in the article is presented in a very simplified manner, not in sufficient detail for professionals, but just right for patients.

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

The pituitary gland (synonym: pituitary gland) is a rounded 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 an increased production of some hormone inside it, and then "along the chain" in the adrenal glands, which it controls. A pituitary tumor is often an endocrinological cause of hypertension. Read the details 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, above the kidneys.

If a tumor develops in one or both of the adrenal glands, then this causes an overproduction of some hormone, which, in turn, causes hypertension. Moreover, such hypertension is usually persistent, malignant and cannot be treated with pills. The production of some hormones in the adrenal gland is controlled by the pituitary gland. Thus, there are 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 overproduction of the following hormones in the adrenal glands:

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

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

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

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

Dopamine increases cardiac output and improves blood flow. From dopamine under the action of enzymes, norepinephrine is produced, and from it is already adrenaline, which is the end product of the biosynthesis of catecholamines.

So, we figured out a little about hormones, now we will list directly the endocrine causes of hypertension:

Pheochromocytoma is a tumor of the adrenal gland that causes an increased production of catecholamines. In 15% of cases, it is not in the adrenal glands, but in the abdominal cavity or chest.
Primary hyperaldosteronism is a tumor in one or both of the adrenal glands that causes too much aldosterone to be produced.
Itsenko-Cushing's syndrome, aka 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 - due to a tumor in one or both of the 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) produced by the parathyroid glands. Not to be confused with the thyroid gland! Parathyroid hormone increases the concentration of calcium in the blood due to the fact that it flushes this mineral from the bones.
Hyper- and hypothyroidism - high or low levels of thyroid hormones.

If you do not treat the listed diseases, but simply give the patient pills for hypertension, then usually this does not allow enough to reduce the pressure. To bring the pressure back to normal, to avoid a heart attack and stroke, you need to participate in the treatment of a whole team of competent doctors - not only an endocrinologist, but also a cardiologist and surgeon with golden hands. The good news is that the treatment options for endocrine-induced hypertension have expanded significantly over the past 20 years. Surgery has become much safer and more effective. In some situations, timely surgical intervention allows you to normalize the pressure so much that you can cancel the constant intake of 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 that 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 either for money, much less for nothing. Look for a sensible specialist based on the reviews of friends. Surely it will be useful to go to the regional center, and even to the capital of your state.

Below is detailed information that will help you understand the course of treatment: why they are taking this or that event, prescribing medications, how to prepare for surgery, etc. Note that today, among patients with endocrine hypertension, not a single major serious study has been carried out, which would meet the criteria of evidence-based medicine. All information about the methods of treatment, which is published in medical journals, and then in books, is collected from the world on a string. Doctors exchange experience with each other, gradually generalize it, and so universal recommendations appear.

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

Usually it is a benign tumor, but in 10% of cases it turns out to be malignant and gives metastases. V? 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 a pheochromocytoma and how abundantly it produces hormones.

Among all patients with arterial hypertension, approximately 0.1-0.4%, i.e., in 1-4 patients out of 1000, pheochromocytoma is found. In this case, the pressure can be increased all the time or by seizures. The most common symptoms are headache, increased sweating, and tachycardia (palpitations). If blood pressure is elevated, but these symptoms are not, then it is unlikely that the cause is pheochromocytoma. There are also hand tremors, nausea, vomiting, visual disturbances, attacks of fear, sudden pallor or, on the contrary, redness of the skin. About y? patients are found to be stable or sometimes elevated blood glucose and even sugar in the urine. In this case, the person inexplicably loses weight. If the heart is damaged due to the increased level of catecholamines in the blood, then symptoms of heart failure develop.

Frequency of the main symptoms in pheochromocytoma

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

The symptoms of pheochromocytoma are not unambiguous, they are different in different patients. Therefore, it is impossible to make a diagnosis only on the basis of 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 the standard diagnostic procedure for suspected pheochromocytoma. Before taking tests in advance, patients need to stop taking medications in advance that increase or vice versa inhibit the production of hormones-catecholamines in the body. These are the following drugs: adrenergic blockers, adrenostimulants, including centrally acting, MAO inhibitors and others.

If possible, then compare the content in the urine of metabolic products of catecholamines in a normal situation and immediately after a hypertensive crisis. It would be nice to do the same with blood plasma. But this would require taking blood through a venous catheter, which must be installed 30-60 minutes in advance. It is impossible to keep the patient at rest all this time, and then so that he has a hypertensive crisis on schedule. A vein blood test is stress in itself, which increases the concentration of adrenaline and norepinephrine in the blood and thus leads to false positive results.

Also, for the diagnosis of pheochromocytoma, functional tests are used, in which they inhibit or stimulate the secretion of catecholamines. 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 after 3 hours. Compare the content of adrenaline and norepinephrine in both analyzes. Or they test how much the intake of clonidine suppresses the production of catecholamines at night. To do this, make analyzes of urine collected overnight. In a healthy person, after taking clonidine, the content of adrenaline and norepinephrine in nighttime urine will significantly decrease, while in a patient with pheochromocytoma, it will not.

Stimulation tests are also described in which patients receive histamine, tyramione, and best of all, glucagon. From taking stimulating drugs in patients with pheochromocytoma, blood pressure increases significantly, and the content of catecholamines increases several times, much more than in healthy people. To avoid a hypertensive crisis, patients are first given alpha-blockers or calcium antagonists. These are drugs that do not interfere with 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 catastrophe in the patient.

The next stage in the diagnosis of pheochromocytoma is to identify the location of the tumor. For this, a computed tomography or magnetic resonance imaging is performed. If the tumor is in the adrenal glands, then it is usually easily detected, often even with the help of ultrasound, which is the most accessible examination. But if the tumor is not located in the adrenal glands, but somewhere else, then whether it will be possible to identify it depends largely on the experience and the will to victory 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 you have to do a radioisotope scan using a contrast agent. 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, X-ray examination is more informative. Metaiodbenzylguanidine is used as a contrast agent. A radioisotope scan using a contrast agent can cause kidney failure and has other risks as well. 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 place where the tumor is located. If the definition of this place was not mistaken, then the concentration of hormones will be several times higher than in the blood taken from other vessels. Such an analysis is prescribed if a pheochromocytoma is found in the adrenal glands. However, this is a complex and risky analysis, so they try to do without it.

For the treatment of pheochromocytoma, a surgical operation is performed to remove the tumor, if there are no contraindications to it. The good news for patients is that surgeons have introduced laparoscopy in recent years. This is a method of performing operations in which the incision in the skin is very small and the inside is also minimally damaged. Thanks to this, recovery takes no more than 2 weeks, and earlier 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 by surgery, 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 decreases, due to which the condition of the patients improves.

What pills for pressure 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 agents can stimulate additional production of catecholamines. The function of the patient's cardiovascular system should be carefully monitored at all stages of surgical treatment: during the introduction of anesthesia, then during the operation and the first day after it. Because severe arrhythmias, a strong decrease in blood pressure or, on the contrary, hypertensive crises are possible. In order for the volume of circulating blood to remain sufficient, it is necessary for the patient to receive enough fluid.

2 weeks after the operation, it is recommended to pass a urine test for catecholamines. Sometimes, over time, there are relapses of the tumor or additional pheochromocytomas are found, in addition to the one that was removed. In such cases, re-surgery is recommended.

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 of the adrenal glands that causes too much aldosterone to be produced. These tumors can be of different types. In any case, the excess production of aldosterone causes the level of potassium in the blood to decrease and the 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 at the same time 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 all called the renin-angiotensin-aldosterone system. It is a closed loop system. We will mention that some medications block its action so that blood pressure does not rise. 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, that is, it acts at an earlier stage than the drugs we mentioned above. All this is not directly related to the endocrinological causes of hypertension, but it is useful for patients to know the mechanisms of drug action.

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

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

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

Normally, when a person gets up from a sitting or lying position, they produce renin, which quickly raises blood pressure. If there is an adrenal tumor that produces excess aldosterone, then renin secretion is blocked. Therefore, orthostatic hypotension is possible - dizziness and even fainting with a sharp change in body position.

We list other possible symptoms of primary hyperaldosteronism:

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

The symptoms seen 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 impossible to make a diagnosis. Primary hyperaldosteronism should always be suspected if the patient has severe drug-resistant hypertension. Moreover, if the level of potassium in the blood is normal, then this does not exclude that the production of aldosterone is increased.

The most significant analysis for diagnosis is the determination of the concentration of the 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. And they start preparing very early, 14 days in advance. It is advisable at this time to stop taking all pressure pills, balance the diet, and take care of stress. It is better for the patient to go to the hospital for the preparatory period.

What blood tests do:

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. Blood levels of aldosterone should drop at night. 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 value 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 more than 50, then almost certainly the patient has primary hyperaldosteronism. Calculation of this ratio has been widely introduced into clinical practice only recently. As a result, it turned out that every tenth patient with hypertension suffers from primary hyperaldosteronism. In this case, the level of potassium in the blood may be normal and decrease only after the test with salt load for several days.

If the results of blood tests, which are listed above, do not allow a definite diagnosis, then additionally tests with a load of salt or captopril are performed. Salt load 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 makes it possible to clarify the results of tests for the content of aldosterone in the blood. If hyperaldosteronism is secondary, then the salt load will inhibit the production of aldosterone, but if it is primary, then it will not. The 25 mg captopril test is the same. If the patient has hypertension due to kidney problems or for other reasons, then 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 an ultrasound scan. But even if the ultrasound does not show anything, it is still impossible to completely exclude the presence of an adenoma or adrenal hyperplasia. Because in 20% of cases, the tumor is less than 1 cm in size, and in this case it will not be easy to find it. Computed or magnetic resonance imaging should always be done if primary hyperaldosteronism is suspected. There is also a method for determining the concentration of aldosterone in the blood from the adrenal veins. This method allows you to determine if there is a problem in one adrenal gland or in both.

Blood pressure in patients with primary hyperaldosteronism can literally go off the scale. Therefore, they are especially susceptible to the formidable complications of hypertension: heart attacks, strokes, renal failure. Also, a low level of potassium in the blood in many of them provokes the development of diabetes mellitus.

Above, at the beginning of the section on this disease, we gave 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 a correct diagnosis to distinguish unilateral aldosterone-producing adenoma from bilateral adrenal hyperplasia. The latter is considered a milder disease, although it is less susceptible to surgical treatment. If the lesion of the adrenal glands is bilateral, then the operation can normalize the pressure in less than 20% of patients.

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If an operation is planned, then before it, the content of aldosterone in the blood, which flows from the veins of the adrenal glands, should be determined. Let's say you have found an adrenal tumor as a result of an ultrasound scan, 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 adrenal cortex tumors are found at any age in 0.5-10% of people. They do not create any problems, and you do not need to do anything with them.

Patients with primary hyperaldosteronism from hypertension are prescribed spironolactone, a specific aldosterone blocker. Potassium-sparing diuretics are also used - amiloride, triamterene. Spironolactone is taken 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 stably normal, then thiazide diuretic drugs are also prescribed in small doses.

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

First, let's introduce the terminology:

Cortisol is one of the hormones that is 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 brain regions. Stimulates or inhibits the production of hormones by the pituitary gland and thus controls the human endocrine system.
Corticotropin-releasing hormone, aka corticorelin, corticoliberin, is produced in the hypothalamus, acts on the anterior lobe of the pituitary gland and causes the secretion of adrenocorticotropic hormone there.
Ectopic is one that is located in an unusual location. Excessive cortisone production 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's syndrome, aka hypercortisolism, is a disease in which too much of the hormone cortisol is produced. Hypertension occurs in about 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.
The adrenocorticotropic hormone signals the adrenal glands to synthesize cortisol.

Itsenko-Cushing's 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.
In one of the adrenal glands, a tumor develops, while the levels of adrenocorticotropic hormone in the blood are normal.
An ectopic tumor that is not in the pituitary gland and produces adrenocorticotropic hormone.
There are also rare reasons that 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, there is a secondary increase (hyperplasia) of the adrenal glands. This is called Cushing's disease. In almost 20% of cases, the primary cause is an adrenal tumor, and this is not called a disease, but Cushing's syndrome. More often there is a one-sided tumor of the adrenal glands - adenoma or carcinoma. Bilateral adrenal tumor is rare, called micro- or macronodular hyperplasia. Cases of bilateral adenoma have also been described.

Classification of the causes of hypercortisolism

Spontaneous hypercortisolism
Cushing's disease (pituitary hypercortisolism)
Ectopic production of adrenocorticotropic hormone
Ectopic corticotropin-releasing hormone production	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
Cushing's pseudo-syndrome (alcoholic, depression, HIV infection)

Itsenko-Cushing's syndrome is more common in women, usually between the ages of 20-40. In 75-80% of patients, it is difficult to locate the tumor, even with the use of modern methods of computed and magnetic resonance imaging. However, the initial diagnosis of the disease is not difficult because chronic elevated blood cortisol levels cause typical changes in patients' appearance. This is called the cushingoid type of obesity. Patients have a moon-like face, purple-blue cheeks, fat deposits in the neck, trunk, shoulders, abdomen and thighs. In this case, the limbs remain thin.

Additional symptoms of elevated blood cortisol levels:

Osteoporosis and fragility of bones.
Low concentration of potassium in the blood.
A tendency to bruise.
Patients lose muscle mass, look infirm, stoop.
Apathy, drowsiness, loss of intelligence.
The psycho-emotional state often changes from irritability to deep depression.
Stretch marks of the skin on the abdomen, purple, 15-20 cm long.

Symptoms of elevated blood levels of adrenocorticotropic hormone and pituitary tumors:

Headaches caused by a pituitary tumor that presses on the inside.
Body skin pigmentation.
In women - menstrual irregularities, atrophy of the mammary glands, the 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 a disease, because the level of this hormone physiologically fluctuates within wide limits. In urine, it is recommended to determine the indicators of free cortisol, and not 17-keto and 17-hydroxyketosteroids. Measurements should be made in at least two consecutive 24-hour urine samples.

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

The next step 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 produces 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, then 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 seen from the results of a blood test.

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

Tumors causing increased cortisol production are searched for with 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, 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 high doses of hormones. For such cases, magnetic resonance imaging is considered the most sensitive examination method.

The cause of Itsenko-Cushing's syndrome is a tumor that produces an “extra” hormone, cortisol. Such a tumor may be located in the pituitary gland, adrenal glands, or elsewhere. A real way of treatment that gives a long-term effect is the surgical removal of the problematic tumor, wherever it is. Neurosurgery methods for removing pituitary tumors in the 21st century have developed significantly. In the world's best clinics, the rate of complete 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's syndrome

Within six months after the removal of the pituitary tumor, the patient's cortisol level is 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, then both adrenal glands are surgically removed. However, after this, the production of adrenocorticotropic hormone by the pituitary gland still increases. As a result, the patient's skin color may darken significantly within 1-2 years. This is called Nelson's syndrome. If an ectopic tumor produces adrenocorticotropic hormone, then it is highly likely to be malignant. In this case, chemotherapy is needed.

With hypercortisolism, the following drugs can theoretically be used:

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

However, doctors know that there is little sense from these drugs, and the main hope is for surgical treatment.

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

Acromegaly is a condition caused by the overproduction of growth hormone. This hormone is also called growth hormone, growth hormone, growth hormone. 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 at a young age, then such people grow up to be giants. If it starts later, then the following clinical signs appear:

coarseness of facial features, including a massive lower jaw, developed superciliary arches, protruding nose and ears;
the hands and feet are disproportionately enlarged;
there is also excessive sweating.

These signs are very characteristic, so any doctor can easily make the initial diagnosis. To determine the final diagnosis, you need to take blood tests for growth hormone, as well as for insulin-like growth factor. The content of growth hormone in the blood in healthy people never exceeds 10 μg / l, and in patients with acromegaly, it does. 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 believed to be the ability of growth hormone to retain sodium in the body. There is no direct relationship between blood pressure and the level of growth hormone in the blood. In patients with acromegaly, significant hypertrophy of the left ventricular myocardium is often observed. It is due not so much to high blood pressure as to changes in hormonal levels. Because of it, the level of cardiovascular complications among patients is extremely high. The mortality rate is about 100% within 15 years.

For acromegaly, the usual, common first-line pressure medications are prescribed, alone or in combination. Efforts are directed to the treatment of the underlying disease by surgical removal of the pituitary tumor. After surgery, blood pressure in most patients drops or returns to normal. At the same time, the content of growth hormone in the blood is reduced 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 about 20% of patients with acromegaly. Also, short-term administration of octreotide, an analogue of somatostatin, suppresses the secretion of growth hormone. All of these measures can lower blood pressure, but the real long-term treatment is surgery or X-rays of the pituitary tumor.

Parathyroid glands (parathyroid glands, parathyroid glands) - four small glands located along 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 swelling of the parathyroid gland.

Hyperparathyroidism leads to the fact that bone tissue is replaced by connective tissue in the bones, and calcium stones are formed in the urinary tract. The physician should suspect this disease if the patient's hypertension is combined with an increased calcium content in the blood. In general, arterial hypertension is observed in about 70% of patients with primary hyperparathyroidism. Moreover, parathyroid hormone itself does not increase blood pressure. Hypertension occurs due to the fact that with a prolonged course of the disease, renal function is impaired, the vessels lose the ability to relax. The parathyroid hypertensive factor is also produced - an additional hormone that activates the renin-angiotensin-aldosterone system and increases blood pressure.

By symptoms, without tests, it is impossible to immediately diagnose. Bone manifestations - pain, fractures. From the side of the kidneys - urolithiasis, renal failure, secondary pyelonephritis. Depending on which symptoms predominate, two forms of hyperparathyroidism are distinguished - renal and bone. Tests show an increased content of calcium and phosphate in the urine, an excess of potassium and a lack of electrolytes in the blood. X-rays show signs of osteoporosis.
Blood pressure rises already in the initial stages of hyperparathyroidism, and target organ lesions develop especially rapidly. Normal parameters 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. Also, ultrasound and tomography of the parathyroid gland is 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 is normalized according to various sources in 20-100% of patients. Pressure pills for hyperparathyroidism are prescribed, as usual - first-line drugs, singly or in combination.

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

A huge number of people have problems with the thyroid gland, especially women over 40 years old. 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 will greatly shorten life and worsen 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;
heart attacks (tachycardia);
symptoms of chronic heart failure;
the skin is warm and moist;
hair is thin and silky, early gray hair is possible;
the upper blood pressure is rather increased, while the lower one can be lowered.

The main symptoms of a lack of thyroid hormones are:

obesity resistant to trying 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, exfoliate.

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. Conversely, if the concentration of this hormone is below normal, then the thyroid gland is too active.
Free T3 and Free T4. If the indicators of these hormones are not normal, then the thyroid gland needs to be treated, even despite the good numbers of thyroid-stimulating hormone. There are often disguised thyroid problems in which thyroid-stimulating hormone levels are normal. Such cases can only be detected by tests for free T3 and free T4.

Endocrine and cardiovascular changes in diseases of the thyroid gland

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

Hyperthyroidism and thyrotoxicosis are one and the same disease, an increased production of thyroid hormones, which speed up the metabolism. Cardiac output, pulse rate and myocardial contractility increase. The volume of circulating blood increases, and the peripheral vascular resistance decreases. The upper blood pressure is rather increased, while the lower one can be lowered. This is called systolic hypertension, or high pulse pressure.

Let your endocrinologist prescribe the therapy for hyperthyroidism. This is a broad topic that goes beyond the hypertension treatment site. As pills for pressure, beta-blockers are considered the most effective, both selective and non-selective. Some studies have shown that non-selective beta-blockers can reduce excess synthesis of thyroid hormones T3 and T4. It is also possible to prescribe nondihydropyridine calcium antagonists, which slow the heart rate. If left ventricular hypertrophy of the heart is expressed, then ACE inhibitors or angiotensin II receptor blockers are prescribed. Diuretic medications complement the effects of all of these medications. It is undesirable to use dihydropyridine calcium channel blockers and alpha-blockers.

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

Analyzes show that in those patients who developed hypertension against the background of hypothyroidism, the level of adrenaline and norepinephrine in the blood is increased. Elevated diastolic "lower" blood pressure is characteristic. The top pressure may not rise because the heart is sluggish. It is believed that the more the lower pressure is increased, the more severe the hypothyroidism, that is, the more acute the lack of thyroid hormones.

Hypothyroidism is treated with pills prescribed by an endocrinologist. When the therapy begins to work, then the state of health improves and the pressure in most cases returns to normal. Have repeated thyroid hormone tests every 3 months to adjust the dosage of the tablets. In elderly patients, as well as with a long “experience” of hypertension, treatment is less effective. These categories of patients need to take blood pressure pills along with hypothyroidism medications. Usually, ACE inhibitors, dihydropyridine calcium antagonists, or alpha-blockers are prescribed. You can also add diuretic medications to enhance the effect.

We have looked at the main endocrine causes other than diabetes that cause high blood pressure. Typically, in such cases, traditional methods of treating hypertension do not help. It is possible to steadily bring the pressure back to normal only after the underlying disease has been brought under control. In recent years, doctors have made progress in meeting this challenge. The development of the laparoscopic approach in surgical operations is especially encouraging. As a result, the risk for patients decreased, and recovery after operations accelerated by about 2 times.

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

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

The rarest endocrine causes of hypertension remained outside 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 any 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 his participation, blood pressure normalizes. It is one of the links in a complex hormonal chain - renin-angiotensin-aldosterone. If a failure occurs in this system, the consequences for the human body can be most serious.

Renin functional tasks

Renin - what is it? Renin is a peptide hormone that is synthesized during complex biochemical processes. It has a great effect on the work 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. It is synthesized 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 when:

the person has suffered severe stress;
there is a decrease in the blood circulating in the vessels;
blood supply to the kidneys worsens;
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 the level of blood pressure, since when it rises, the adrenal cortex secretes aldosterone more intensively.

Clinical study for renin

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

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

Standing and lying position

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

Sitting or standing position (with habitual salt intake) - 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 a seated position, while following a low-salt diet, numbers from 4.2 to 19.8 ng / ml / h are considered normal. In the prone 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 body of the expectant mother significantly increases. As a result, renin values can double. But by 20 weeks, this violation disappears.

Aldosterone-Renin Ratio

The rate of the aldosterone-renin ratio (ARC) is 3.8 to 7.7, respectively. This study is a screening marker for primary hyperaldosteronism.

Assignment for analysis

Increased and decreased renin are equally dangerous phenomena that require compulsory medical intervention. A clinical study of blood plasma can help to identify abnormalities. It requires careful preparation, which should begin 3-4 weeks before the scheduled test date.

So, you can prepare for the 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 drugs, as well as drugs that may affect the reliability of the results.
Refuse to use products containing caffeine - with their regular use, renin is significantly increased in almost all patients. Consequently, the results will be unreliable.

In addition, there are a few more simple rules to follow. 24 hours before the test, it is necessary to stop taking diuretics, hormonal contraceptives, ACE inhibitors, lithium, etc. You should refuse from dinner before the analysis, and the day before it should be excluded from drinking and smoking.

Reasons for increasing renin

The reasons why renin is elevated are often associated with:

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

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

Violation of the aldosterone-renin ratio

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

If the aldosterone is increased, but the renin indicators remain normal, then such a deviation may indicate a dysfunction of the adrenal cortex. In any case, all deviations upward are not the norm, especially if, in addition to hormones, sodium in the blood has also been disturbed.

Thus, low renin with normal aldosterone is not always considered as a signal that there are any pathological processes in the human body. Again, only if sodium and potassium levels are within normal limits. If their content is also reduced, the doctor prescribes additional instrumental diagnostic methods to find out the reasons for the deviation.

The reasons for the increased renin in the blood, as you can see, can be very different. But since ARS plays a huge role in the diagnosis of diseases of the endocrine system, it is inappropriate to make a diagnosis based on the results of laboratory research to identify one specific substance from this chain.

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

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

Many people call a renin valve, the scheme of which can be described as the functioning of a sprinkler: if you reduce the diameter of the duct, the flow becomes much greater. However, the jet itself becomes smaller. Renin is excreted by the kidneys, in Latin it means the renal component.

The juxtaglomerular apparatus - special kidney cells - 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;
Decrease in the amount of blood that circulates through the body;
Decreased blood supply to the renal ducts;
Low levels of potassium or sodium in your blood;
Low blood pressure.

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

High levels of the hormone renin

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

No one can be surprised by the ever-leaping pressure - life in a metropolis changes. In addition, it is influenced by the frequency of drinking alcohol, the level of physical activity, 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

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

Increased blood pressure due to renin

Congestive heart failure

The appearance of muscle weakness;
The mucous membranes of the whole body become inflamed;
Severe shortness of breath appears even with mild exertion;
Tachycardia or arrhythmia appears;
Numerous edema occurs due to fluid retention.

Without complex 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, severe pain occurs on palpation... If the renin level is not brought back to normal in time, the likelihood of severe diseases of many organs and systems is high. An increase in renin provokes the production of bilirubin, which in large quantities leads to non-alcoholic cirrhosis.

chives, since they undergo hydrolysis followed by the precipitation of hydroxides. The forms of iron migration in soil-ground waters change seasonally: during the spring flood, with a large amount of suspended material, suspended forms prevail, during low-water periods (seasonal lowering of the water level in rivers), organic matter plays a large role in the transfer of iron. The most important sources of input of chemical, including biogenic elements into natural waters are divided into two large groups: external and internal. External sources provide the flow of substances into water bodies with river runoff, atmospheric precipitation, industrial, household and agricultural wastewater. Internal sources accumulate chemical elements due to the processes of inflow from the flooded bed of reservoirs, mineralization of woody, meadow and higher aquatic vegetation and dead plankton, as well as bottom sediments.

4. Organic matter in natural waters

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

Natural waters contain organic matter in relatively low concentrations. The average concentration of organic carbon in river and lake waters rarely exceeds 20 mg / l. In sea and oceanic waters, the C content is even lower. The content of proteinaceous 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 outside) include organic acids, esters, carbohydrates, 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 units of milligrams per liter. A significant part of the organic matter of natural waters is made up 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 only a few or tens of milligrams per liter. In sea and oceanic waters, the average content of humic substances is lower and rarely exceeds 3 mg / l.

By origin, organic substances of natural waters are divided into two large groups:

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

2) organic matter entering water bodies from the outside with river runoff, precipitation, industrial, household and agricultural waste waters, - allochthonous substances. A special place in this group is occupied by humic substances of soils, peat bogs, and forest litters.

Organic matter of 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 weight humic substances. However, some of the colored organic compounds - fulvic acids and some forms of humic acids - can be in the state of true solutions. Natural waters are characterized by the migration of organic matter in the form of suspensions, for example, detritus, consisting of the smallest organic and inorganic residues formed during the decay of dead organisms. A special place among these phenomena is occupied by complexation, which has a positive 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. Dissolved

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 the belonging to one or another class of water. However, the mineral composition of the water is not the only factor that determines the quality of the water.

Organic matter is one of the most complex in terms of the qualitative composition of the groups of compounds contained in natural waters, it includes organic acids, phenols, humic substances, nitrogen-containing compounds, carbohydrates. Organic matter of natural waters can be in the state of true solutions, colloids and suspended coarse particles (suspensions).

In the formation of the chemical composition of natural waters, direct and indirect, as well as main and secondary 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, odor, etc.), but do not affect

its class and type.

Control questions

1. What ions are the main ones, regardless of the origin of the waters?

2. What organic matter is 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 belong to the category of brines?

Organic carbon

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

The composition and content of organic matter in natural waters is determined by the combination of many processes that are different in nature and speed: posthumous and lifetime excretions of aquatic organisms; inputs with atmospheric precipitation, with surface runoff as a result of the interaction of atmospheric waters with soils and vegetation on the surface of the catchment; receipts from other water bodies, from swamps, peat bogs; receipts with 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 the associated seasonal variations in chemical composition, temporary changes in the intensity of biological processes. In the bottom layers of water bodies and in the surface film, the content of organic carbon can differ significantly from its content in the rest of the water.

Organic substances are in water in dissolved, colloidal and suspended states, forming a kind of 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 hazardous substances that pollute surface waters. Oil and its refined products are an extremely complex, unstable and diverse mixture of substances (low and high molecular weight, unsaturated aliphatic, naphthenic, aromatic hydrocarbons, oxygen, nitrogenous, sulfur compounds, as well as unsaturated heterocyclic compounds such as resins, asphaltenes, anhydrides, asphaltene acids). The concept of "petroleum products" in hydrochemistry is conditionally limited only to the hydrocarbon fraction (aliphatic, aromatic, alicyclic hydrocarbons).

Large quantities of petroleum products enter surface waters during the transportation of oil by water, with wastewater from oil-extracting, oil-refining, chemical, metallurgical and other industries, and with domestic water. Some quantities of hydrocarbons enter the water as a result of the excretions of plants and animals in vivo, as well as as a result of their posthumous decomposition.

As a result of the processes of evaporation, sorption, biochemical and chemical oxidation occurring in the reservoir, the concentration of oil products can significantly decrease, while their chemical composition can undergo significant changes. The most stable are aromatic hydrocarbons, the least stable are n-alkanes.

Oil products are in various migration forms: dissolved, emulsified, sorbed on solid particles of suspended matter and bottom sediments, in the form of a film on the water surface. Usually, at the moment of arrival, the mass of oil products is concentrated in the film. With distance from the source of pollution, a redistribution occurs between the main forms of migration, directed towards an increase in the proportion of dissolved, emulsified, sorbed petroleum products. The quantitative ratio of these forms is determined by a set of factors, the most important of which are the conditions for the entry of oil products into the water body, the distance from the discharge point, the rate of flow and mixing of water masses, the nature and degree of pollution of natural waters, as well as the composition of oil products, their viscosity, solubility, density, boiling point of the components. When sanitary-chemical control is determined, as a rule, the amount of dissolved, emulsified and sorbed forms of oil.

The adverse effects of oil products affect the human body, wildlife, aquatic vegetation, the physical, chemical and biological state of the reservoir in various ways. Low molecular weight aliphatic, naphthenic and especially aromatic hydrocarbons included in petroleum products have a toxic and, to some extent, narcotic effect on the body, affecting the cardiovascular and nervous systems. The most dangerous are polycyclic condensed hydrocarbons of the 3,4-benzopyrene type, which have carcinogenic properties. Oil products envelop the plumage of birds, the surface of the body and organs of other aquatic organisms, causing disease and death.

The negative effect of oil 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 oil 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 is dispersed organic matter in the rocks. In its pure form, it is sometimes present in bogs, formed during the rotting of bog vegetation. This gas in natural waters is in a molecular dispersed state and does not enter into chemical interaction with water.

Benzene

Benzene is a colorless liquid with a characteristic odor.

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

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

The taste with a benzene content in water of 1.2 mg / dm3 is measured in 1 point, with 2.5 mg / dm3 - in 2 points. The presence of benzene in water (up to 5 mg / dm3) does not change the processes of biological oxygen consumption, since under the influence of biochemical processes in water benzene is weakly oxidized. In concentrations of 5-25 mg / dm3, benzene does not delay the mineralization of organic substances, 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, the process of wastewater treatment in aeration tanks. At a content of 885 mg / dm3, benzene strongly inhibits the fermentation of the sediment 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, and the 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 - vapor-volatile phenols (phenol, cresols, xylenols, guaiacol, thymol) and non-volatile phenols (resorcinol, pyrocatechol, hydroquinone, pyrogallol and other polyatomic phenols).

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

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

In surface waters, phenols can be in a dissolved state 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 water bodies, the processes of phenols adsorption by bottom sediments and suspensions play an insignificant role.

The excess of the natural background for phenol can serve as an indication of the pollution of water bodies. In natural waters polluted with phenols, their content can reach tens and even hundreds of micrograms per 1 dm3. Phenols are unstable compounds and undergo biochemical and chemical oxidation.

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

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

The discharge of phenolic waters into water bodies and watercourses sharply worsens their general sanitary condition, influencing living organisms not only by their toxicity, but also by a significant change in the regime of biogenic elements and dissolved gases (oxygen, carbon dioxide).

As a result of chlorination of water containing phenols, stable chlorophenol compounds 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. Vapor-volatile phenols are more toxic and have a more intense odor when chlorinated. The most pungent odors are produced by simple phenol and cresols.

Hydroquinone

Hydroquinone gets into surface waters with wastewater from the production of plastics, film and photo materials, dyes, and oil refining enterprises.

Hydroquinone is a potent reducing agent. Like phenol, it has a weak disinfecting effect. Hydroquinone does not impart odor to water, the taste appears at a concentration of several grams per 1 dm3; the threshold concentration for the color of water 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 cause death of trout eggs.

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

Alcohols Methanol

Methanol gets into reservoirs with waste water from the production and use of methanol. The wastewater of the pulp and paper industry contains 4.5-58 g / dm3 of methanol, the production of phenol-formaldehyde resins - 20-25 g / dm3, varnishes and paints 2 g / dm3, synthetic fibers and plastics - up to 600 mg / dm3, waste waters of generating stations operating on brown coal, coal, peat, wood - up to 5 g / dm3.

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

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

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

Ethylene glycol

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

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

Ethylene glycol is highly toxic. When it enters the stomach, it acts mainly on the central nervous system and kidneys, and also causes hemolysis of erythrocytes. Ethylene glycol metabolites are also toxic - aldehydes and oxalic acid, which cause the formation and accumulation of calcium oxalates in the kidneys.

Organic acids

Organic acids are among the most common components of natural waters of various origins and often constitute a significant part of all organic matter in these waters. The composition of organic acids and their concentration are determined, on the one hand, by intra-water body processes associated with the life of algae, bacteria and animal organisms, on the other hand, by the intake of these substances from the outside.

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

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

postmortem discharge associated with the death and decay of cells;

excretions by communities associated with biochemical interactions 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 floods and floods, with atmospheric precipitation, industrial and domestic wastewater, and with waters discharged from irrigated fields.

Volatile acids

Volatile acids are understood to mean the sum of the concentrations of formic and acetic acids.

Formic acid

In natural waters, formic acid is formed in small quantities in the processes of life and posthumous decomposition of aquatic organisms and the biochemical transformation of organic substances contained in water. Its increased concentration is associated with the discharge of wastewater from enterprises producing formaldehyde and plastics based on it into water bodies.

Formic acid migrates mainly in a dissolved state, in the form of ions and undissociated molecules, the quantitative ratio between which is determined by the dissociation constant К25 ° С = 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 effluents from the chemical industry.

Propionic acid can impair the organoleptic properties of water, giving it a smell and sour-astringent taste. The most significant for propionic acid is the adverse effect 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 of aquatic organisms in life processes and posthumous decomposition and the biochemical transformation of organic substances contained in water.

Lactic acid is found in water mainly in a dissolved state in the form of ions and undissociated molecules, the quantitative ratio between which is determined by the dissociation constant К25 ° С = 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 mainly determined by the intensity of biochemical processes in the water.

Benzoic acid

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

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

Benzoic acid practically does not possess toxic properties. Its unfavorable effect on the reservoir is associated with a change in the oxygen regime and pH of the water.

Humic acids

Humic and fulvic acids, combined under the name humic acids, often make up a significant proportion of organic matter in natural waters and are complex mixtures of biochemically stable high molecular weight compounds.

The main source of humic acids entering natural waters are soils and peat bogs, from which they are washed out by rain and swamp waters. A significant part of humic acids is introduced into water bodies together 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 ratios between which are determined by the chemical composition of the waters, pH, the biological situation in the reservoir and other factors.

The presence in the structure of fulvic and humic acids of carboxyl and phenol hydroxyl groups, amino groups contributes to the formation of strong complex compounds of humic acids with metals. Some of the humic acids are in the form of low-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, complicating disinfection and obtaining highly pure water, and accelerating the corrosion of metals. They also affect the state and stability of the carbonate system, ionic and phase equilibria and the distribution of migratory forms of trace elements. An increased content of humic acids can have a negative effect on the development of aquatic plant and animal organisms as a result of a sharp decrease in the concentration of dissolved oxygen in the reservoir, which is used for their oxidation, and their destructive effect on the stability of vitamins. At the same time, during the decomposition of humic acids, a significant amount of products valuable for aquatic organisms is formed, and their organomineral complexes are the most easily assimilated form of plant nutrition with microelements.

Soil acids: humic (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 fluctuates over a wide range (from 500 to 200,000 and more). The relative molecular weight is conventionally assumed to be 1300-1500.

Fulvic acids

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

Organic nitrogen

Under "organic nitrogen" is meant 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 part of nitrogen-containing organic compounds enters natural waters in the process of the death of organisms, mainly phytoplankton, and the decay 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 lifetime excretion by aquatic organisms. Among the significant sources of nitrogen-containing compounds are also 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 ingress of industrial, agricultural and domestic wastewater into water bodies.

Urea

Urea (carbamide), being one of the important waste products of aquatic organisms, is present in natural waters in noticeable concentrations: up to 10-50% of the total nitrogen-containing organic compounds in terms of nitrogen. Significant amounts of urea enter water bodies with domestic wastewater, collector water, and also with surface runoff in areas where it is used as nitrogen fertilizer. Urea can accumulate in natural waters as a result of natural biochemical processes as a metabolic product of aquatic organisms, produced by plants, fungi, bacteria as a product of ammonia binding formed in the process of protein dissimilation. Extraorganismic enzymatic processes have a significant effect on the concentration of urea. Under the action of enzymes, the mononucleotides of dead organisms disintegrate with the formation of purine and pyrimidine bases, which in turn decompose due to microbiological processes to urea and ammonia. Under the action of a specific enzyme (urease), urea decomposes to an ammonium ion and is consumed by aquatic plant organisms.

An increase in the concentration of urea may indicate pollution of the water body with agricultural and domestic wastewater. It is usually accompanied by the activation of the processes of urea utilization 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 decarboxylases of bacteria and fungi and amination;

seaweed;

precipitation;

waste water from aniline-colored enterprises.

Amines are present mainly 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 ones, diamines are more toxic than monoamines; isomeric aliphatic amines are more toxic than normal aliphatic amines; monoamines are more likely to be hepatotoxic and diamines are more likely to be nephrotoxic. The highest toxicity and potential hazard among aliphatic amines are characterized by unsaturated amines due to their most pronounced ability to inhibit the activity of amino oxidases.

Amines, present in water bodies, have a negative effect on the organoleptic properties of water, and can aggravate freezing phenomena.

Aniline

Aniline refers to aromatic amines and is a colorless liquid with a characteristic odor.

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

Aniline has the ability to oxidize hemoglobin to methemoglobin. Urotropin

Hexamethylenetetramine - (CH2) 6N4

Nitrobenzene

Nitrobenzene is a colorless or greenish-yellow oily liquid with a bitter almond odor.

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

Organic sulfur Methyl mercaptan

Methyl mercaptan is a metabolic product of living cells. It also comes with waste water from the pulp industry (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 the ionic form, at pH 13, complete dissociation occurs. Methyl mercaptan is stable for less than 12 hours, forms salts - mercaptides.

Dimethyl sulphide

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

Dimethyl sulfide cannot persist for a long time in the water of reservoirs (it is stable from 3 to 15 days). It is partially transformed with the participation of algae and microorganisms, and mainly evaporates into the air.

At concentrations of 1-10 μg / dm3, dimethyl sulfide has a 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 the cellulose industry.

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 vital secretions of algae, biochemical and photochemical oxidation of alcohols and organic acids, decomposition of organic substances such as lignin, metabolism of bacteriobenthos. The constant presence of carbonyl compounds among the oxygen compounds of oil and in water in contact with hydrocarbon deposits makes it possible to consider the latter as one of the sources of enrichment of natural waters with these substances. Terrestrial plants are also a source of carbonyl compounds, in which aldehydes and ketones of the aliphatic series and furan derivatives are formed. A significant part of aldehydes and ketones enters natural waters as a result of human activities.

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, the production of varnishes and paints, plastics, film, acetylene, acetaldehyde, acetic acid, plexiglass, phenol, acetone.

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

For aquatic organisms, acetone is relatively low toxic. 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 contained in wastewater from the main organic synthesis industries, plastics, varnishes, paints, pharmaceuticals, leather, textile and pulp and paper industries.

Formaldehyde has been reported in rainwater in urban areas. Formaldehyde is a powerful reducing agent. It condenses with amines and forms urotropine with ammonia. In the aquatic environment, formaldehyde is biodegradable. Under aerobic conditions at 20 ° C, decomposition takes about 30 hours, under anaerobic conditions, about 48 hours. Formaldehyde does not decompose in sterile water. Biodegradation in the aquatic environment is due to the action of Pseudomonas, Flavobacterium, Mycobacterium, Zanthomonas.

The subthreshold concentration, which does not affect the sanitary regime of water bodies and saprophytic microflora, is 5 mg / dm3; the maximum concentration that does not cause a violation of biochemical processes under 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. Skin resorptive action is possible. Formaldehyde is irritating, allergenic, mutagenic, sensitizing, carcinogenic.

Carbohydrates

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

In surface waters, carbohydrates are in a dissolved and suspended state 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, Ya.P. Molchanova, E.A. Zaika, V.N. Vinichenko, E.M. Averochkin

Their primary production is divided into oligotrophic (unproductive), mesotrophic (moderately productive), eutrophic (highly productive) and hypereutrophic (too productive). 3. Saprobity of water bodies The degree of pollution of water bodies with organic substances determines their saprobity (sapros-decaying), and the section of hydroecology, which studies such pollution, is saprobiology. Aquatic organisms ...

Oil, studied at different levels - from general physicochemical properties to molecular reactions - served as the basis for the developed methodology for studying the organic matter of oil-contaminated geosystems and was used to identify sources of hydrocarbon pollution in the Usolka water intake. The presence of oil products in the composition of aquabitumoids of surface and groundwater intake ...