Screen for Endocrine Hypertension, Endocrine Society Says

Veronica Hackethal, MD

April 12, 2017

The Endocrine Society has released a new scientific statement about screening for endocrine hypertension.

The statement, published in the April issue of Endocrine Reviews, provides guidance on screening for 15 hormonal disorders that present with hypertension and that can be potentially cured with surgery or treated with medication.

"Without appropriate lab tests, some common endocrine disorders are nearly indistinguishable from a routine case of hypertension," Endocrine Society past president William F Young, Jr, MD, MSc, from the Mayo Clinic in Rochester, Minnesota, said in a press release. Dr Young chaired the task force that drew up the scientific statement.

"Screening for underlying causes of high blood pressure can save lives. This new resource offers healthcare providers valuable guidance on when to suspect a hormone disorder and how to test for it," he added.

Hypertension often represents the presenting symptom in over 15 endocrine disorders. About 15% of people who present with high blood pressure have secondary hypertension, often caused by an underlying disorder in the renal or endocrine system. Those rates rise to over 50% among children and about 30% among young adults under age 40 who present with high blood pressure.

The statement reviews potential causes of endocrine hypertension, with a focus on prevalence, clinical presentation, guidance on diagnostic testing, and interpretation of results.

Specifically, the authors provide information on primary aldosteronism, which is caused by overproduction of aldosterone by the adrenal glands and results in excess sodium reabsorption by the kidneys and high blood pressure.

Primary aldosteronism should be considered in most patients who present with hypertension, according to the statement. Between 5% and 10% of patients with hypertension may have primary aldosteronism, now thought to be the most common, treatable, and potentially curable form of hypertension. Untreated, the condition can increase the risk of cardiovascular events, including death and stroke.

"Healthcare providers should consider primary aldosteronism screening for most people who have hypertension," Dr Young said in a press release. "The condition can be easily treated and often cured when it is diagnosed. Early detection also reverses the elevated risk of cardiovascular events and kidney failure in this population."

The statement also reviews other causes of endocrine hypertension, including tumors that secrete stress hormones, thyroid disorders, obstructive sleep apnea, acromegaly, disorders of the renal vasculature, Cushing syndrome, parathyroid gland disorders, and obstructive sleep apnea,

Overall, the statement recommends a screening approach that considers the clinical context. For example, detecting hormonal causes of hypertension may be a lower priority in older patients with multiple serious comorbidities. On the other hand, screening for endocrine hypertension could make a big difference to younger patients, for whom it could enhance and prolong life.

Dr Young reports consulting for Nihon Medi-Physics. Disclosures for the coauthors are listed in the paper.

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Endocr Rev. 2017;38:103-122. Article

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