Diagnosing endocrine hypertension: a practical approach

Hypertension is a leading cardiovascular risk factor that remains difficult to manage in a large segment of the population. Secondary causes of hypertension, which are amenable to targeted treatment or even cure, may contribute to poor blood pressure control. The most common endocrine cause, primary aldosteronism, requires biochemical screening as there are often no symptoms or signs other than hypertension. Screening tests should be performed after adequate preparation to optimize the results and minimize the confounding effects of diet and medications. Further testing beyond the initial screen generally requires input from specialist units to coordinate confirmatory tests and radiological procedures. Other less common or even rare endocrine causes of hypertension generally present with symptoms and signs of pituitary, adrenal, thyroid or parathyroid dysfunction rather than hypertension per se. Here, we review the endocrine causes of hypertension and provide a practical approach to their diagnosis.