Endocrine Forms of Hypertension: Clinical and Emerging Molecular Aspects

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Background

Endocrine disorders associated with arterial hypertension account for a high proportion of cases of secondary hypertension. Although in some patients the clinical features associated with such endocrine disorders can be strongly suggestive of the diseases, most endocrine forms of arterial hypertension remain undetected until an accurate diagnostic work-up is made. Thus, an early identification of the cause(s) of endocrine hypertension is crucial for treatment, and for the reduction of morbidity and mortality related to these disorders. In this sense, it is relevant to have a comprehensive approach to the diagnosis and management of endocrine hypertension.

The most common form of endocrine hypertension is primary aldosteronism (PA), which occurs in 5% to 20% of hypertensive patients. Even though most physicians are aware that PA is not a rare disease, it is often overlooked not only because it mimics essential hypertension, but also because the work-up for screening PA is often perceived as complex and unfeasible. PA remains under-diagnosed despite there are evidences that PA is associated with cardiovascular and renal damage more severe than that found in patients with essential hypertension having comparable blood pressure values. Moreover, an appropriate treatment in PA can reduce the risk. In fact, in patients with lateralized excess aldosterone production, adrenalectomy can cure the biochemical picture of PA with excess aldosterone, and also cures, or ameliorates, hypertension.

Other conditions that cause endocrine hypertension include pheochromocytoma, Cushing’s syndrome, congenital adrenal hyperplasia, Liddle syndrome, acromegaly, thyroid diseases, and primary hyperparathyroidism. These diseases are often unrecognized, mostly because the diagnostic work-up is seen as challenging. A clear picture of the clinical signs that should raise alertness in the physician, as well as definition of the GP’s and the endocrinologist’s work-up could be helpful for diagnosing these endocrine forms of arterial hypertension.

In the last decades, knowledge of the mechanisms underlying endocrine forms of arterial hypertension, mostly PA and pheochromocytoma, greatly changed our view on pathophysiology of such diseases. A deeper insight into mechanistic aspects is undoubtedly relevant for translational medicine, hoping that it could offer new strategies for these diseases in the next future.

The major aims of the Research Topic are 1) to give a comprehensive view of the molecular mechanism underlying the different endocrine forms of arterial hypertension and 2) to offer a practical approach to the diagnosis and management of such diseases.

Keywords: Hypertension, Endocrine, Aldosterone, Cortisol, Adrenal

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