Cushing's disease in a child. Cushing's syndrome

Itsenko-Cushing's disease in children is a disorder of the pituitary gland, in which an excessive amount of hormones responsible for normal work adrenal glands This leads to an increase in the size of the adrenal glands and excess production of the hormone corticosteroid.

Cushing's disease and syndrome

The disease and Itsenko-Cushing syndrome are the same disease, which only differs in that with the disease there is a pronounced lesion of the pituitary gland, and with the syndrome there is no such sign. Itsenko-Cushing syndrome in children is hereditary. All symptoms and manifestations of the disease and syndrome are identical.

Causes of the disease

You can select following reasons Itsenko-Cushing's disease:

increased secretion of adrenocorticotropic hormone by the pituitary gland, which is provoked by a benign tumor;
damage to the adrenal cortex, in which a tumor develops (most often benign);
secretion of adrenocorticotropic hormone by tumors in other parts of the body (most often the testes, ovaries, thyroid and pancreas);
long-term use medications, especially hormonal ones;
genetic disorders.

Symptoms of the disease

Itsenko-Cushing's disease has characteristic complaints and signs.

Its first manifestation in a child is excessive obesity.

External changes

This initial symptom indicates a disturbance in carbohydrate metabolism. Symptoms increase gradually. After an increase in body weight, it begins to develop general weakness. The child quickly gets tired and loses interest in outdoor games. Obesity is progressing rapidly. The fat layer forms more in the abdomen, chest, and around the face.

The neck becomes noticeably shorter due to fat deposits in the seventh vertebra. The face takes on a moon-shaped shape, facial expressions lose expression, and a bright blush appears on the entire surface of the cheeks, which practically does not disappear.

Upper and lower limbs don't get fat, but in the background general increase weights look dystrophic. Note that on the buttocks body fat are missing. The muscles of the back and lower back gradually atrophy and cannot properly support the body, which leads to diseases of the spine.

The skin has increased dryness, which provokes the formation of strip-like stretch marks, which are most often located in the lower abdomen, on the surface of the thighs and chest. The stripes have a bright red tint. A marble pattern appears throughout the skin. There is also severe fragility and changes in the structure of the nails, the appearance of moles and warts, acne, etc. The hair on the head becomes brittle and falls out profusely. Girls experience excess hair in the pubic area, thighs, back and face. In boys, facial hair growth begins at early age. The bristles are very thick and hard.

The skeleton undergoes significant changes. On x-rays Osteoporosis of bones, especially tubular bones, is clearly visible. It leads to frequent fractures limbs and vertebrae, which are caused by changes in bone structure and overweight. The child often suffers from pain in the skeleton.

Internal changes

Another striking symptom of Itsenko-Cushing's disease is a violation functional work of cardio-vascular system. It is expressed in a significant increase in blood pressure, which reaches 220 mm Hg. Art. During examination large vessels there is a significant change in their walls. The capillaries become dilated and often burst. The heart muscle becomes weak, losing its tone. This leads to insufficient blood circulation, which causes a lack of oxygen in the internal organs and skin. When performing an echocardiogram, a violation of the structure of the heart muscle tissue is clearly visible.

Another distinct symptom of the disease is delayed sexual development of the child, although secondary sexual characteristics, on the contrary, develop rapidly. Delayed sexual development is especially observed in girls, which most often manifests itself in quite late start menstrual cycle(in most cases at 14-15 years old).

There is a deviation in the functioning of the kidneys, which leads to increased level in the urine of erythrocytes and hyaline casts. A blood test reveals high level hemoglobin, leukocytosis and lymphopenia.

Itsenko-Cushing's disease is progressive. Symptoms are increasing rapidly. Rapid obesity of the body leads to disruption of all its functions. If there is no treatment, the child dies within three years after the first symptoms appear.

Diagnostic methods

It is worth noting that Itsenko-Cushing's disease is quickly diagnosed if the attending physician has the appropriate experience and professionalism. However, in small district hospitals in most cases, the child is treated for obesity. Such therapy does not bring results and significantly aggravates the clinical picture. To confirm the diagnosis of Itsenko-Cushing's disease, the following must be done: diagnostic procedures:

Daily monitoring of urine analysis to analyze cortisol production.
Carrying out a small dexamethozone test. In the absence of illness, after administration of the drug, cortisol levels should decrease significantly. In the presence of illness, the hormone level does not change or, on the contrary, increases.
Carrying out a large dexamethozone test. It allows you to detect the presence of tumors of the adrenal glands or other organs that affect the production of the hormone.
Magnetic resonance imaging can detect a pituitary tumor.
Used to detect adrenal tumors ultrasonography and magnetic resonance imaging.
An X-ray of the spine allows you to evaluate the structure of the skeleton and the degree of its damage.
Echocardiogram of the heart.
Other additional tests and diagnostic procedures that allow you to assess the condition of the child’s body.

Treatment methods

Treatment methods for Cushing's disease depend on its cause. If the disease was provoked by long-term use medicines, then their reception is stopped. The child is observed by the attending physician for several months with periodic diagnostic measures.

If the disease is caused by genetic changes in the body that cause increased secretion of adrenocorticotropic hormone, then constant use of Dexamethasone is prescribed. Such a child should be constantly monitored by a doctor who monitors the level of the hormone and the dosage of the drug.

If it is determined that the cause of the disease is a tumor, then its removal is prescribed. There are several ways to remove a pituitary or adrenal tumor:

Surgical. This is the most effective and common method of treatment. Using a scalpel, the surgeon excises the tumor. Most often it is benign, so it does not metastasize. Surgical intervention is not prescribed in cases of possible intolerance surgical intervention and too large a pituitary tumor, the removal of which can significantly worsen the condition and functionality sick.
Radiation therapy. This method is also very effective. The tumor is destroyed under the influence of special gamma radiation.
Chemotherapy. The patient is given special aggressive medications that are designed to destroy the tumor.

Along with the main treatment, the child is prescribed special vitamin and mineral complexes that will help restore internal organs, skin and bone structure. To reduce body weight, diet and restorative exercise are prescribed.

How to avoid the disease

Methods for the prevention of Itsenko-Cushing's disease that will protect against the occurrence of this disease in children do not exist today. Only close attention of parents to their children will allow timely identification of signs of the disease and treatment.

Parents should immediately be wary and consult a doctor if the child begins to gain weight for no reason.

Treatment of this disease is early stages allows you to quickly normalize the level of adrenocorticotropic hormone. However, as already mentioned, in most cases it is required surgical intervention to remove the tumor, and the reasons for its formation are not fully understood today.

Adrenal gland - small paired organ, which plays a big role in the functioning of the body. Itsenko-Cushing syndrome is often diagnosed, in which the cortex internal organ produces an excess of glucocorticoid hormones, namely cortisol. In medicine, this pathology is called hypercortisolism. It is characterized by severe obesity, arterial hypertension and various disorders in metabolism. Most often, the deviation is observed in women under 40 years of age, but hypercortisolism is often diagnosed in men.

general information

Hypercortisolism is a disease of the adrenal glands, which results in significantly increased levels of cortisol in the body. These glucocorticoid hormones are directly involved in regulating metabolism and many physiological functions. The adrenal glands are controlled by the pituitary gland through the production of adrenocorticotropic hormone, which activates the synthesis of cortisol and corticosterone. In order for the pituitary gland to function normally, sufficient production of specific hormones by the hypothalamus is necessary. If this chain is disrupted, the entire body suffers and this affects the person’s health.

Hypercorticism in women is diagnosed ten times more often than in the stronger sex. Medicine also knows Itsenko-Cushing's disease, which is associated with primary damage to the hypothalamic-pituitary system, and the syndrome has a secondary degree. Doctors often diagnose pseudo-syndrome, which occurs against the background of alcohol abuse or severe depression.

Classification

Exogenous

Exogenous hypercorticism can be provoked by long-term use of synthetic hormones.

The development of exogenous hypercortisolism is influenced by prolonged use of synthetic hormones, resulting in an increase in the level of glucocorticoids in the body. This is often observed when a person is very sick and needs to take hormonal drugs. Often, exogenous syndrome manifests itself in patients with asthma and rheumatoid arthritis. The problem may occur in people after an internal organ transplant.

Endogenous

The development of the endogenous type of syndrome is influenced by disorders that occur inside the body. Most often, endogenous hypercortisolism occurs in Cushing's disease, which results in an increase in the amount of adrenocorticotropic hormone (ACTH) produced by the pituitary gland. For development endogenous hypercortisolism influence malignant tumors(corticotropinomas), which form in the testicles, bronchi or ovaries. In some cases, primary deviations of the organ cortex can provoke pathology.

Functional

Functional hypercortisolism or pseudo-syndrome is a temporary condition. Functional deviation may be associated with intoxication of the body, pregnancy, alcoholism or disorders mental state. Youthful hypothalamic syndrome often leads to functional hypercortisolism.

At functional disorder The same symptoms are observed as in the classic course of hypercortisolism.

The main causes of Itsenko-Cushing syndrome

Pituitary adenoma as a provoking factor in the production of hormones by the adrenal glands.

To date, doctors have not been able to fully study the reasons that affect the disorder. It is only known that with any factor that provokes an increase in the production of hormones by the adrenal glands, the disease develops. Provoking factors are considered:

adenoma arising in the pituitary gland;
formation of tumors in the lungs, pancreas, bronchial tree, which produce ACTH;
long-term use of glucocorticoid hormones;
hereditary factor.

In addition to the above factors, the occurrence of the syndrome may be influenced by the following circumstances:

brain injury or concussion;
traumatic brain injuries;
inflammation arachnoid spinal cord or brain;
inflammatory process in the brain;
meningitis;
bleeding into the subarachnoid space;
damage to the central nervous system.

Development mechanism

If a person has at least one of the above factors, then a pathological process may start. The hypothalamus begins to produce the hormone corticoliberin in large quantities, which leads to an increase in the amount of ACTH. Thus, hyperfunction of the adrenal cortex occurs; it is forced to produce glucocorticoids 5 times more. This provokes an excess of all hormones in the body, as a result the function of all organs is disrupted.

External manifestations and symptoms

Increased weight gain is a symptom of adrenal Cushing's syndrome.

Adrenal Cushing's syndrome manifests itself with many symptoms that are difficult to ignore. Main characteristic feature hypercortisolism is increased weight gain. A person can for short period acquire 2nd or 3rd degree obesity. In addition to this symptom, the patient has the following abnormalities:

Leg muscles atrophy and upper limbs. The person complains of fatigue and constant weakness.
The condition is getting worse skin: They dry out, acquire a marbled tint, and the elasticity of the skin is lost. A person may notice stretch marks and notice slow healing of wounds.
Suffering and sexual function, which is manifested by a decrease in libido.
IN female body hypercortisolism is manifested by hair growth male type, the menstrual cycle is disrupted. In some cases, periods may disappear altogether.
Osteoporosis develops, in which the density decreases bone tissue. In the first stages, the patient is bothered by pain in the joints, and over time, causeless fractures of the legs, arms, and ribs occur.
The functioning of the cardiovascular system is disrupted, which is associated with negative hormonal influence. Angina pectoris, hypertension, and heart failure are diagnosed.
In most cases, hypercortisolism provokes steroid-induced diabetes mellitus.

Cushing's syndrome has a negative impact on hormonal background patient, unstable emotional condition: depression alternates with euphoria and psychosis.

Pathology of the adrenal glands in children

In children, abnormalities in the functioning of the adrenal glands occur for the same reasons as in adults. Children with hypercortisolism experience dysplastic obesity, in which the face becomes “moon-shaped”, the fat layer on the chest and abdomen increases, and the limbs remain thin. The disease is characterized by myopathy, hypertension, systemic osteoporosis, and encephalopathy. In children, there is a delay in sexual development, as well as secondary immunodeficiency. Hypercortisolism in children causes them to grow more slowly. In a teenage girl, after the start of the menstrual cycle, amenorrhea is possible, in which menstruation may be absent for several cycles.

Itsenko-Cushing syndrome in children and adults occurs for the same reasons and manifests itself in both dysplastic obesity and neurological disorders.

When contacting a specialist, the first thing he will pay attention to is the child’s enlarged face; the cheeks will be painted purple. Due to the fact that there is an excess of androgens in the body, the teenager experiences increased acne, the voice becomes rougher. Children's body becomes weaker and more susceptible to infectious lesions. If you do not pay attention to this fact in a timely manner, sepsis may develop.

Possible complications

Cushing's syndrome, which progressed to chronic form can lead to the death of a person, since it provokes a number of severe complications, namely:

cardiac decompensation;
stroke;
sepsis;
severe pyelonephritis;
chronic kidney failure;
osteoporosis, in which numerous spinal fractures occur.

Hypercortisolism gradually leads to adrenal crisis, in which the patient experiences disturbances in consciousness, arterial hypotension, observed frequent vomiting, painful sensations V abdominal cavity. Are decreasing protective properties immune system, resulting in furunculosis, suppuration and fungal infection skin. If a woman is pregnant and is diagnosed with Itsenko-Cushing syndrome, then in most cases a miscarriage occurs or the pregnancy ends in a difficult birth with many complications.

This disease, associated with damage to the interstitial pituitary region, was first described in 1926 by N. I. Itsenko. Cushing described it in 1932 as pituitary syndrome. It is believed that the disease can occur after encephalitis or meningitis. There are indications of the frequent presence of basophilic pituitary adenoma, as well as hyperplasia of the adrenal cortex in Itsenko-Cushing's disease. However, it has not yet been clarified whether basophilic adenoma or hyperplasia of the adrenal cortex occurs primarily.

In foreign literature, Itsenko-Cushing's disease is usually identified with Cushing's syndrome. In this case, the primary localization of the lesion is assumed in the interstitial pituitary region, the anterior lobe of the pituitary gland or in the adrenal cortex.

In our country, Itsenko-Cushing's disease is considered only as a disease associated with damage to the interstitial pituitary region, and Cushing's syndrome is understood as characteristic group symptoms with metabolic disorders observed with damage to the adrenal glands.

Pathogenesis

The pathogenesis of the disease is extremely complex. And although numerous studies have been devoted to this issue, it has not yet been completely resolved. It has been suggested that the changes occurring in the pituitary gland are associated with the presence, in turn, of changes in the hypothalamic region (in the nuclei of the hypothalamus). Changes in the pituitary gland, in particular the development of basophilic adenoma in it, lead to increased production of ACTH, which leads to hyperplasia of the adrenal cortex.

In children, the disease is very rare: within 5 years of the child’s existence clinical department At the Institute of Experimental Endocrinology and Hormone Chemistry of the Academy of Medical Sciences, we observed only 20 children with Itsenko-Cushing’s disease.

Symptoms of Itsenko-Cushing's disease

The clinical picture of Itsenko-Cushing's disease and the complaints of such patients are very typical. Usually parents begin to notice that the child is overweight. This is one of the important initial symptoms associated with a violation carbohydrate metabolism. Then general weakness develops, increased fatigue. Obesity progresses, and fat is deposited more in the abdomen, chest, face, neck, which becomes short; typical fat deposition in area VII cervical vertebra. Particularly characteristic is the deposition of fat in the face: it takes on a moon-shaped shape, is somewhat amicable, there is a bright crimson-red blush on the cheeks, the limbs do not change, but look against the background general obesity even thinner. Fat is also not deposited on the buttocks area. There is atrophy of the muscles of the proximal shoulder and pelvic girdle (proximal amyotrophy).

Thus, redistribution of fat, i.e., its excessive deposition in specified areas of the body, is especially typical for Itsenko-Cushing disease.

Noteworthy is the increased dryness of the skin and the formation of so-called stretch marks, located mainly in the abdominal area, on inner surface thighs, chest and often having a bright red or cyanotic appearance. In general, the skin with the syndrome in question has a characteristic marble pattern. Acrocyanosis is noted, dystrophic changes nails, the presence of warts, acne, etc. The hair on the head is sparse and often falls out. It is typical, especially for girls, to have hirsutism: excess hair growth in the pubic area, thighs, and back. Excessive hair growth inappropriate for age can also occur in boys.

At x-ray examination find significant changes in the skeleton: osteoporosis is quite pronounced tubular bones and spine; the vertebrae look as if they were made of glass. With Itsenko-Cushing's disease, apathy and decreased mobility of children are observed, but nevertheless, due to osteoporosis, fractures of the bones of the extremities can easily occur, compression fractures vertebrae The phenomena of osteoporosis explain pain in various locations.

One of the cardinal signs of the disease is damage to the cardiovascular system, expressed in a significant increase in blood pressure. Maximum arterial pressure in children may exceed 220 mmHg. Art., and the minimum reaches 160 mm. There are pronounced changes in the vessel wall. Capillaroscopy reveals a cloudy background, the branches of the capillaries are widened. Electrocardiography data indicate a conduction disorder. Also violated contractility myocardium, which is confirmed by ballistocardiographic studies.

With Itsenko-Cushing's disease, failure of the cardiovascular system manifests itself in children as clearly as in adults. Cardiovascular functional tests and such methods of heart examination as ballistocardiography, X-ray kymography, etc., allow early detection of these disorders.

Children with Itsenko-Cushing's disease are always delayed sexual development, although secondary sexual characteristics may even be enhanced. There are also abnormalities in renal function: albuminuria is observed, red blood cells and hyaline casts appear in the urine.

Blood tests often reveal neutrophilic leukocytosis, eosinopenia and lymphopenia, high content hemoglobin.

The course of Itsenko-Cushing's disease is usually progressive. Quite quickly, fullness increases with a characteristic distribution of fat and the whole body develops. clinical picture. Without appropriate therapy, the disease leads to death within 2-3 years.

From additional methods studies for this disease should be called: suprarenopneumography, determination of excretion in urine of 17-ketosteroids and 17-hydroxycorticosteroids, determination of sodium and potassium in blood serum, and sugar in blood and urine, construction of a glycemic curve.

It should also be taken into account that Itsenko-Cushing's disease in childhood and prepubertal age is exclusively rare disease. If a child develops a picture of total hypercortisolism, especially if the entire symptom complex has developed rapidly - over several months, you should always think first about an adrenal tumor.

Treatment

Treatment of Itsenko-Cushing's disease is a complex and not yet solved problem. So far, therapy consists of irradiation of the interstitial-pituitary region in a total dose of 2500-3000 g. Usually prescribed from 80 to 100 g every other day.

IN last years Bilateral subtotal resection of the adrenal glands is more readily used. We observed an effect both with radiotherapy and with subtotal resection of the adrenal glands. The goal of treatment should be to mitigate not only the symptoms of Itsenko-Cushing's disease, but also the phenomena of cardiovascular failure and other symptoms. However, the prognosis for this disease is always very serious.

Itsenko-Cushing syndrome in children is a mechanism that unites a group of diseases that appear in the body due to increased production of the hormone hydrocordisone. Hydrocordisone is produced by the adrenal cortex. The With syndrome is also called hypercortisolism.

With hypercortisolism, different pathological processes contribute to the production large quantity hormones. Such processes include hyperplasia, adenoma, cancerous tumor adrenal cortex.

Symptoms of Itsenko-Cushing syndrome in children are rare, although the severity of the course is not inferior to any other endocrine disease. The disease usually affects older children.

Causes and etiology of the development of the disease in children:

Long-term use of medications that contain glucocorticoid hormones;
Excessive production of cortisol in the adrenal cortex;
The causes of 15-19% of cases of the syndrome are initial injury to the adrenal cortex as a result of hyperplastic tumor formations - adenoma, adenomatosis, adenocarcinoma;
The causes of the disease lie in ACTH-ectopic syndrome - swelling of the secreting corticotropic hormone;
A rare etiology is heredity;
The characteristic causes of the development of the disease are electrolyte disorders.

Symptoms

The main symptoms of the syndrome: dysplastic obesity, hypertension, skin lesions, osteoporosis, encephalopathy, myopathy, metabolic disorders.

Symptoms of Cushing's syndrome in children include overproduction of cortisol. This substance affects the protein structures of most tissues in the body (bones, muscles, skin, etc.). Pathogenesis has the following symptoms: in some areas of the body fat is deposited in excess (often affecting the face), while in others there is no fat at all. By examining the symptoms of pathogenesis, doctors identify exactly how the development occurs. of this syndrome in children.

Dysplastic obesity – the face becomes larger than other parts of the body.

Symptoms trophic change skin: hirsutism – appearance excess growth terminal hair throughout the body, striae - stretch marks in the shape of stripes. Striae are considered a form of skin atrophy, have a color ranging from white to red-violet, and are located in those areas that are most susceptible to stretching. They do not cause physical discomfort and become invisible over time.

Mechanism of damage to the cardiovascular system: arterial hypertension, left ventricular hypertrophy, hypertension.

Symptoms characteristic of systemic osteoporosis: secondary hypogonadism and immunodeficiency, encephalopathy, myopathy, disturbances of electrolyte and carbohydrate metabolism.

Encephalopathy can be congenital and acquired (brain damage associated with botulism, infections, alcoholism, injuries, hypovitaminosis, vascular diseases). With encephalopathy, tissues are completely deformed and brain functions are disrupted.

Myopathy is a congenital developing hereditary neuromuscular disease, usually characterized by primary lesion muscles.

Diagnostics

To diagnose the disease the following is used:

Daytime urinary free cortisol excretion;
Diagnostics is based on step-by-step calculation of the amount of medication in the blood before use (it has anti-inflammatory and antiallergic properties) and after. If the amount of cortisol decreases by more than half, it is considered an acceptable phenomenon;
Differential diagnosis between pathogenetic types of the syndrome and spinal corticosteroma;
MRI – diagnostics reveals pituitary adenomas;
Computed tomography and MRI of the adrenal glands;
X-ray of the spine - diagnostics is used to identify exacerbations of the disease;
Biochemical analysis - identifying malfunctions in the body and determining the presence of diabetes.

Treatment

Treatment accelerates regeneration permissible quantity hormones of the adrenal cortex in the body. Treatment is carried out in several ways: pathogenetic treatment, symptomatic therapy hypercorticism.

Radiation therapy

To treat a disease, a mechanism is used that connects the components radiation therapy, namely gamma therapy and proton irradiation of the pituitary gland.

Gamma therapy is a disease of lung and medium degree treated with small clumps of heavy charged particles. Proton irradiation of the pituitary gland is no less effective in treating the disease. The difference between proton irradiation of the pituitary gland and gamma therapy:

High dose of radiation;
Nearby organs are not damaged;
Only one procedure is performed;
Subsequent irradiation of the pituitary gland can be carried out after six months;
Proton therapy.

Surgical

Surgical treatment combines transsphenoidal adenomectomy, adrenal decomposition and adrenalectomy. Due to the rapid development of microsurgical technology, doctors have developed the most suitable way to treat Itsenko-Cushing's disease, which is based on the use of transsphenoidal adenomectomy.

Adrenalectomy during illness is performed both unilateral and bilateral. A combination of radiation therapy and unilateral adrenalectomy is used for middle stage diseases. Bilateral adrenalectomy is used for last stage or development of exacerbations of hypercortisolism.

Drug treatment

To cure Cushing's disease, medications are used that can suppress the release of corticotropin by the pituitary gland. It is forbidden to treat the disease with these medications before using radiation therapy, otherwise its effectiveness will decrease.

Medicines that suppress the secretion of corticotropin, a substance of this type, reduce its secretion and facilitate the course of the disease.

They are treated with Parlodel - the drug inhibits the release of adenohypophysis hormones. This medicine is used to treat Itsenko-Cushing syndrome, but only after radiation therapy. It is advisable to use parlodel when the dose of prolactin in the body is increased.

Peritol is an antiserotonin drug that reduces the release of corticotropin by affecting the serotonergic system.

Many patients complain of Nelson's syndrome, a frequent companion to Cushing's disease. To cure the syndrome, medications are used to prevent the secretion of corticotropin.

Destruction of the adrenal glands consists of damaging the hyperplastic organ by penetrating it with a special liquid or ethanol. The method is used exclusively for general treatment.

GABAergic medications

GABAergic drugs occupy a leading place among stopping neurotransmitters and have a beneficial effect during encephalopathy. GABAergic drugs are used if Nelson's syndrome is detected after radiation therapy. These include: minalon, convulex.

Steroidogenesis blockers

Blockers located in the adrenal glands can be divided into: medications that eliminate the biosynthesis of corticosteroids and provoke the breakdown of particles of the adrenal cortex, and medications that eliminate the biosynthesis of steroids.

Chloditan - must be taken to improve the functioning of the adrenal cortex during the preparation of seriously ill patients for unilateral and bilateral adrenalectomy.

Aminoglutethimide

Treatment with aminoglutethimide must be carried out simultaneously with artificial monitoring of liver function and the presence of platelets in the blood. To treat the disease with steroidogenesis blockers, hepatoprotectors (Essentiale or Carsil) are simultaneously prescribed.

Hypotheptic therapy

Symptomatic treatment of hypercortisolism and arterial hypertension, it is better to use adelfan, adelfan-esidrex and potassium chloride. At the same time, treatment is carried out for steroid cardiopathy, hapokaliempi, and steroid diabetes mellitus.

Symptomatic therapy for hypertension is aimed at normalizing blood pressure and correcting protein, electrolyte, and carbohydrate metabolism. Without treatment of hypertension, processes in all body systems are disrupted. There are such types of hypertension as: renal, central, hemodynamic, pulmonary, endocrine.