Emotional stress acutely and repetitively causing blood pressure increase or aggravating existing hypertension is usually not reflected by norepinephrine and epinephrine increase but by a sudden rise of dopamine, the third "defensive" catecholamine coping with the damaging neuropsychological and cardiovascular actions of the first two. This double-edged sympathetic response to emotional stress evolves during human lifespan and long-term evolution of hypertension. In the course of philogenesis it carries a potential mismatch between the normal physiology of the human dopaminergic system and current environmental (emotional particularly) conditions in industrialized countries. This offers a rational support to a mental stress-cardiovascular diseases relationship proposed 40 years ago in a WHO report which followed a memorable 1960 Prague Hypertension Meeting.
- MeSH
- dějiny 20. století MeSH
- dopamin fyziologie MeSH
- hypertenze dějiny patofyziologie psychologie MeSH
- lidé MeSH
- psychický stres dějiny patofyziologie MeSH
- Světová zdravotnická organizace dějiny MeSH
- Check Tag
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
Two women with spontaneous hypokalemia (1 normotensive, 1 hypertensive in the absence of renal artery stenosis), underwent unilateral nephrectomy because of angiographic and/or split renin-based suspicion of a reninoma. The normotensive patient clinically resembled Bartter syndrome but had some elements suggestive of a renin-secreting tumour, justifying surgical exploration and resection. The hypertensive patient presented clinically as a typical reninoma except for negative angiography. Surprisingly, the histology of the kidneys in both cases demonstrated juxtaglomerular hyperplasia without evidence of reninoma. The postoperative follow-up (8 and 19 yrs, respectively) has shown in the normotensive patient a considerable improvement in the hyper-reninism and previously uncontrollable hypokalaemia and in the hypertensive patient a complete normalisation of BP, renin and electrolyte status. Although the histological condition of the contralateral kidneys remains unknown in both patients the preoperative lateralisation of hyper-reninism to one kidney, the postoperative complete relief of the hyper-reninism in the hypertensive patient after uninephrectomy and its decrease, exceeding that corresponding to the removal of one kidney in the normotensive patient, suggest that the juxtaglomerular hyperplasia might have been unilateral or asymmetrical and that nephrectomy may, unexpectedly, relieve the hyper-reninism caused by juxtaglomerular hyperplasia. An increased unilateral susceptibility to trophic or renin-releasing factors or an asymmetrical abnormality in the macula densa-initiated mechanism of juxtaglomerular hyperplasia may be implicated in this disorder.
- MeSH
- Bartterův syndrom * diagnóza patologie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- hyperplazie diagnóza etiologie chirurgie komplikace MeSH
- hypokalemie * etiologie chirurgie MeSH
- juxtaglomerulární aparát * patologie MeSH
- ledviny patologie MeSH
- lidé MeSH
- nádory ledvin diagnóza sekrece MeSH
- nefrektomie * MeSH
- renin * krev sekrece MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- dlouhodobě působící stimulátor tyreoidey MeSH
- dospělí MeSH
- hormon uvolňující thyreotropin MeSH
- hormony štítné žlázy MeSH
- hypertyreóza etiologie MeSH
- lidé MeSH
- maternofetální výměna látek MeSH
- novorozenec MeSH
- radioizotopy jodu diagnostické užití MeSH
- štítná žláza fyziologie MeSH
- těhotenství MeSH
- thyreotropin analýza sekrece MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
