Endocrine hypertension: An overview on the current etiopathogenesis and management options

Abstract

Endocrine causes of secondary hypertension include primary aldosteronism, pheochromocytoma, cushing's syndrome, hyperparathyroidism and hypo- and hyperthyroidism. They comprise of the 5%-10% of the causes of secondary hypertension. Primary hyperaldosteronism, the most common of the endocrine cause of hypertension often presents with resistant or difficult to control hypertension associated with either normo-or hypokalemia. Pheochromocytoma, the great mimicker of many conditions, is associated with high morbidity and mortality if left untreated. A complete history including pertinent family history, physical examination along with a high index of suspicion with focused biochemical and radiological evaluation is important to diagnose and effectively treat these conditions. The cost effective targeted genetic screening for current known mutations associated with pheochromocytoma are important for early diagnosis and management in family members. The current review focuses on the most recent evidence regarding causes, clinical features, methods of diagnosis, and management of these conditions. A multidisciplinary approach involving internists, endocrinologists and surgeons is recommended in optimal management of these conditions.

Keywords: Adenoma; Adrenal; Hyperaldosteronism; Pheochromocytoma; Primary aldosteronism.

Figure 1

CT scan of the abdomen demonstrating left adrenal nodule 3.5 cm.

Figure 2

I-123 MIBG – SPECT images demonstrated focal increased tracer activity in the left adrenal nodule compatible with MIBG avid tumor.