How to Explore an Endocrine Cause of Hypertension

Hypertension (HTN) is the most frequent modifiable risk factor in the world, affecting almost 30 to 40% of the adult population in the world. Among hypertensive patients, 10 to 15% have so-called secondary HTN, which means HTN due to an identified cause. The most frequent secondary causes of HTN are renal arteries abnormalities (renovascular HTN), kidney disease, and endocrine HTN, which are primarily due to adrenal causes. Knowing how to detect and explore endocrine causes of hypertension is particularly interesting because some causes have a cure or a specific treatment available. Moreover, the delayed diagnosis of secondary HTN is a major cause of uncontrolled blood pressure. Therefore, screening and exploration of patients at risk for secondary HTN should be a serious concern for every physician seeing patients with HTN. Regarding endocrine causes of HTN, the most frequent is primary aldosteronism (PA), which also is the most frequent cause of secondary HTN and could represent 10% of all HTN patients. Cushing syndrome and pheochromocytoma and paraganglioma (PPGL) are rarer (less than 0.5% of patients). In this review, among endocrine causes of HTN, we will mainly discuss explorations for PA and PPGL.

Automated summary

Hypertension is the most common modifiable risk factor globally, affecting approximately 30% to 40% of adults. Secondary hypertension, resulting from identified causes, accounts for 10% to 15% of hypertensive patients. Renal arteries abnormalities, kidney disease, and endocrine hypertension, primarily due to adrenal causes, are the most frequent secondary causes. Detecting and exploring endocrine causes of hypertension is particularly important as some causes can be cured or have specific treatments available. Screening and exploration for secondary hypertension should be a serious concern for physicians treating hypertensive patients.