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Glukokortikoide und Hypertonie

Glucocorticoids and hypertension

  • Schwerpunkt: Therapierefraktäre und sekundäre arterielle Hypertonie
  • Published:
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Zusammenfassung

80% der Patienten mit einem Morbus Cushing entwickeln eine schwere arterielle Hypertonie. Zusätzlich führt ein chronischer Hyperkortisolismus zu einem metabolischen Syndrom mit Insulinresistenz, Übergewicht, Glukoseintoleranz und Fettstoffwechselstörungen, die ebenfalls zu dem Bluthochdruck beitragen bzw. seine Folgen aggravieren. Diese Effekte entwickeln sich in Abhängigkeit von der Glukokortikoidwirkung auf intrazelluläre Glukokortikoid- und Mineralokortikoidrezeptoren und werden durch die lokale Aktivität der Hydroxysteroiddehydrogenasen modifiziert. Durch die ubiquitäre, sehr spezifische Verteilung der Steroidrezeptoren in verschiedenen Organsystemen führt der Überschuss der Glukokortikoide zu sehr komplexen Veränderungen, die bei endogenem oder exogen induziertem Glukokortikoidüberschuss bedacht werden müssen. Im Mittelpunkt dieses Artikels stehen die Veränderungen der blutdruckregulierenden Systeme, die durch Glukokortikoide hervorgerufen werden und zur Entwicklung der arteriellen Hypertonie beitragen.

Abstract

Severe arterial hypertension is a hallmark of Cushing syndrome which occurs in 80% of the patients. Additionally, persistent cortisol excess induces obesity, hyperinsulinemia with disturbed glucose tolerance and dyslipidemia which all contribute to the development of hypertension and its deleterious sequelae. Cortisol effects are mediated through diversely distributed intracellular glucocorticoid and mineralocorticoid receptors which are protected by the 11-β-hydroxysteroiddehydrogenase type 2 in cells of some organs (i.e. kidney) but not in other. A highly complex clinical picture evolves in case of hypercortisolism due to the ubiquitous distribution of steroid receptors with different affinity and binding capacities for glucocorticoids. The present review focuses on the cortisol induced changes in blood pressure regulation which contribute to the development of hypertension.

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  1. Präklinik - Interdisziplinäres Notfallzentrum, Städtisches Klinikum München Bogenhausen, Englschalkingerstraße 77, 81925, München, Deutschland

    C. Dodt

  2. Medizinische Klinik I , Universitätsklinikum Schleswig Holstein, Campus Lübeck, Lübeck, Deutschland

    J.P. Wellhöner, M. Schütt & F. Sayk

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  1. C. Dodt
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Correspondence to C. Dodt.

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Dodt, C., Wellhöner, J., Schütt, M. et al. Glukokortikoide und Hypertonie. Internist 50, 36–41 (2009). https://doi.org/10.1007/s00108-008-2197-6

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  • DOI: https://doi.org/10.1007/s00108-008-2197-6

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