Abstract
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.
Highlights
Resistant HTN, meaning systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg despite at least three medications including thiazides, renin-angiotensin system blockers (RASb), and calcium channel blockers (CCB); Grade 3 HTN, meaning SBP ≥ 180 mmHg or DBP ≥ 110 mmHg [6]; Grade 2 HTN, especially if there is a poor treatment response, as prevalence increases with HTN severity [6]; HTN at young age; Hypokalemia, whether it is associated or not with diuretic intakes; Adrenal incidentaloma; Family history of primary aldosteronism (PA); Atrial fibrillation unexplained by structural heart disease and other conditions such as hyperthyroidism; Early stroke or disproportionate renal or cardiovascular (CV) complications regarding age or the severity of HTN
This study showed that AVS was not superior to computed tomography (CT); patients with lateralized and non-lateralized AVS were included in the study, and 20% of patients operated on the presence of an adrenal nodule without an AVS were not cured by surgery
Signs and symptoms of pheochromocytoma and paraganglioma (PPGL): spontaneous or provoked; Cardiovascular events with symptoms of PPGL, Takotsubo cardiomyopathy; Young patients (
Summary
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 interesting because some causes have a cure or a specific treatment available. The delayed diagnosis of secondary HTN is a major cause of uncontrolled blood pressure [3]. Regarding endocrine causes of HTN, the most frequent is primary aldosteronism (PA), which is the most frequent cause of secondary HTN and could represent 10% of all HTN patients. Among endocrine causes of HTN, we will mainly discuss explorations for PA and PPGL.
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