Endocrine hypertension is high blood pressure caused by a hormonal excess. Most hypertension is primary, or essential — high blood pressure with no single identifiable cause — but a minority is secondary to an identifiable renal or endocrine condition, and that minority is worth finding because it is often correctable: removing or blocking the hormonal excess can normalise a blood pressure that medication alone only controls.
The idea that organises the topic is that each hormonal cause raises blood pressure in its own way, so each has its own clinical clues, its own tests and its own treatment.
Choose a route through the topic
A reader new to the subject can follow the four notes in order, because each answers the question the one before raises: what the causes are, how they are recognised, how each one raises blood pressure, and how each is treated. A reader who already knows the causes can go straight to the note that answers the question at hand.
- Blood Pressure Classification and Causes of Secondary Hypertension is the place to start. It sets out how blood pressure is graded, how common secondary and endocrine causes are across the age groups, and which endocrine and non-endocrine conditions produce them.
- Diagnosing Endocrine Hypertension explains why an early diagnosis changes treatment, what resistant hypertension means (pressure that stays high despite several antihypertensive drugs), which patients should be screened, and the clinical clues and tests that point to each cause.
- Key Points on Specific Endocrine Causes gives the prevalence, the at-risk groups and the mechanisms for primary aldosteronism (excess aldosterone from the adrenal gland), pheochromocytoma (a catecholamine-secreting tumour) and hypercortisolism (excess cortisol).
- Treatment of Endocrine Hypertension covers how each cause is treated, from adrenal surgery to mineralocorticoid blockade (blocking the receptor through which aldosterone acts), and the preoperative precautions that make resection safe.