Оцінка стану ренін-ангіотензин-альдостеронової системи у ранній діагностиці гормонально-активних пухлин кіркового шару наднирників

Abstract

The purpose of the study was to determine the markers of the state of the renin-angiotensin-aldosterone system in patients with hormonally active tumors of the adrenal cortex layer as predictors of the choice of surgical intervention tactics. Materials and methods. The results of analyzes of clinical and laboratory research of 38 patients with tumors of the adrenal glands in the conditions of the department of endocrine surgery were analyzed. Depending on the type of hormonally active adrenocortical adenoma, all patients were divided into three groups: group I – patients who developed aldosteromas; group II – patients with corticosteromas; group III – patients with corticoaldosteromas. Results and discussion. As a result of research, it was found that the development of hormonally active adrenocortical adenomas in the body is accompanied by an increase in the blood plasma of the concentration of the main adrenal hormones: mineralocorticoid – aldosterone and glucocorticoid – cortisol. These changes are accompanied by dysfunction of the renin-angiotensin-aldosterone system, which is most pronounced in patients with aldosteromas and corticoaldosteromas, which is expressed by an increase in the aldosterone/renin ratio. At the same time, in patients with corticosteromas, as well as with corticoaldosteromas, hormonal imbalance is expressed by an increase in the level of adrenocorticotropic hormone in the blood serum. Hypernatremia and hypokalemia found in patients with corticosteromas may be due to some mineralocorticoid activity of cortisol, which is manifested when it is in excess in the body. In this group of patients, arterial hypertension may also be observed, although it may be less pronounced. Therefore, in order to maintain a normal level of sodium and potassium and prevent an increase in blood pressure, it is necessary to simultaneously determine the concentration of aldosterone, cortisol and renin in the blood, since the functioning of these biologically active substances are closely interconnected. Thus, the determination of the level of aldosterone and cortisol in the blood plasma of patients with hormonally active adrenocortical adenomas serves as a marker for the early diagnosis of the type of hormonally active tumors, the detection of which, along with the study of the renin-angiotensin system and the level of adrenocorticotropic hormone, makes it possible to predict the direction of water-salt exchange in the body Timely establishment of these changes will prevent the risk of developing complications from other organs and systems (cardiovascular, urinary, nervous). Conclusion. It was established that the imbalance of the renin-angiotensin-aldosterone system and the pituitary-adrenal system contributes to the violation of the water-electrolyte balance, which is expressed by hypernatremia and hypokalemia and is most pronounced in patients with a mixed type of adrenocortical adenoma