Description

Endocrine hypertension is high blood pressure caused by an underlying hormonal imbalance. It is often secondary to conditions affecting the endocrine glands and is typically treatable when the root cause is identified. Below is an overview of the common causes, diagnostic approaches, and treatments. Causes of Endocrine Hypertension Primary Aldosteronism (Conn’s Syndrome): Overproduction of aldosterone by the adrenal glands, leading to sodium retention and potassium loss. Key features: Hypertension (often resistant to standard therapy) Hypokalemia (low potassium levels) Metabolic alkalosis Pheochromocytoma: A tumor of the adrenal medulla producing excessive catecholamines (e.g., adrenaline, noradrenaline). Key features: Paroxysmal hypertension (episodic) Sweating, palpitations, headache, anxiety Cushing’s Syndrome: Excess cortisol production by the adrenal glands. Key features: Central obesity, moon face, buffalo hump Hypertension, diabetes, skin thinning, striae Hypothyroidism and Hyperthyroidism: Thyroid hormone imbalances can cause diastolic or systolic hypertension, respectively. Key features: Hypothyroidism: Fatigue, weight gain, bradycardia Hyperthyroidism: Weight loss, tremor, tachycardia Acromegaly: Excess growth hormone (GH) from a pituitary tumor. Key features: Enlarged hands/feet, facial changes Hypertension due to increased vascular resistance Hyperparathyroidism: Excess parathyroid hormone (PTH), leading to hypercalcemia. Key features: Hypertension, kidney stones Bone pain, fatigue, depression Congenital Adrenal Hyperplasia (CAH): Genetic enzyme defects causing abnormal steroid hormone production. Key features: Early-onset hypertension Virilization in some forms Diagnosis Clinical Evaluation: Detailed history (e.g., episodic symptoms, family history). Physical examination (e.g., Cushingoid features, thyroid enlargement). Laboratory Tests: Primary Aldosteronism: Plasma aldosterone-renin ratio (ARR), confirmatory saline infusion or fludrocortisone suppression test. Pheochromocytoma: Plasma or urine metanephrines and catecholamines. Cushing’s Syndrome: 24-hour urinary cortisol, dexamethasone suppression test. Thyroid Disorders: TSH, free T4, T3 levels. Hyperparathyroidism: Serum calcium, PTH levels. Acromegaly: IGF-1, glucose suppression test. Imaging Studies: CT or MRI for adrenal or pituitary tumors. Ultrasound for thyroid or parathyroid glands. Nuclear imaging for functional adenomas. Treatment Options Primary Aldosteronism: Surgical Treatment: Adrenalectomy for unilateral adenomas. Medical Management: Mineralocorticoid receptor antagonists (e.g., spironolactone or eplerenone) for bilateral hyperplasia. Pheochromocytoma: Preoperative Preparation: Alpha-blockers (e.g., phenoxybenzamine) followed by beta-blockers if needed. Surgery: Resection of the tumor. Follow-up: Monitor for recurrence with periodic biochemical testing. Cushing’s Syndrome: Surgery: Resection of adrenal or pituitary tumors. Medical Management: Ketoconazole, metyrapone, or mitotane to suppress cortisol production if surgery is not feasible. Thyroid Disorders: Hypothyroidism: Levothyroxine (thyroid hormone replacement). Hyperthyroidism: Antithyroid drugs (e.g., methimazole), radioactive iodine, or surgery. Acromegaly: Surgery: Transsphenoidal resection of the pituitary tumor. Medical Management: Somatostatin analogs (e.g., octreotide), GH receptor antagonists (e.g., pegvisomant). Hyperparathyroidism: Surgery: Parathyroidectomy for symptomatic cases. Medical Management: Bisphosphonates, calcimimetics in non-surgical candidates. Congenital Adrenal Hyperplasia: Steroid Replacement Therapy: Glucocorticoids and mineralocorticoids to normalize hormone levels. Prognosis Most cases of endocrine hypertension are curable or controllable with proper treatment. Early detection is crucial to prevent complications like cardiovascular disease, kidney damage, or stroke. If you have more specific questions or need guidance for a particular condition, feel free to ask!