The problem of the etiology of hypertension is a complex one, and one that is far from being solved. Although recent studies have greatly modified our views regarding the probable pathogenesis of essential hypertension, and have advanced our understanding of the problem considerably, no etiological factor has been established which will explain all cases. Renal hypertension was induced by Goldblatt (1) in animals by clamping the renal artery, producing a renal ischemia. Renal ischemia has also been produced by numerous other devices, such as ureteral obstruction, constriction of the kidney by a cellophane membrane, partial excision of the kidney, and by experimental nephritis. The renin pressor mechanism which develops as a result of the renal ischemia is responsible for the hypertension in the experimental animal. The evidence that this mechanism is responsible for essential human hypertension is not conclusive. It may account for some cases, but it does not explain the etiology in all cases, nor does it exclude other factors as the primary cause in some and an accessory cause in others. The view that some extrarenal factor may be responsible for the initial renal ischemia has not received much support. The part played by the glands of internal secretion has been studied by Page (2), Goldblatt (3), and others. Hypophysectomy does not prevent the development of experimental renal hypertension, and Goldblatt believes that the pituitary is not important in the mechanism of hypertension of this type. He found, however, that high blood pressure was not well maintained in the absence of the gland. Excision of both gonads, thyroid, and pancreas is also without effect on the development of this kind of hypertension. The only gland definitely implicated is the adrenal. Bilateral adrenalectomy, with consequent removal of adrenal cortical tissue, interferes with the development and maintenance of experimental renal hypertension unless substitution therapy is maintained. It is well known, however, that tumors producing over-activity of the pituitary or the adrenal glands are responsible for the occurrence of high blood pressure and that hypofunction of these glands is characterized by hypotension. Pheochromocytoma and adrenal carcinoma are the most common lesions of the adrenal glands associated with hypertension. Tumors of the pituitary gland may play a role in the mechanism of high blood pressure, the most common being the basophile adenoma or infiltration characteristic of Cushing's syndrome. Acromegaly is often accompanied by hypertension, while Simmond's disease or atrophy of the pituitary usually leads to marked hypotension. The mechanism of these changes, however, is not clear. Renewed interest in the role of the pituitary gland in hypertension has been stimulated by the recent work of Pendergrass, Griffith, and associates.
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