Secondary Arterial Hypertension: From Routine Clinical Practice to Evidence in Patients with Adrenal Tumor

Abstract

Prevalence of arterial hypertension is up to 30-40% in epidemiological studies, it increases with aging and affects the cardiovascular risk. Essential form of hypertension is the most frequent; however, 5-10% of patients are affected by a specific and potentially reversible cause of increased blood pressure levels, called secondary hypertension. In general, all patients with young onset-age (< 40-50 years) or resistant hypertension should be screened for secondary forms. Among them, primary aldosteronism, Cushing's Syndrome and pheochromocytoma are the most common cause of endocrine hypertension associated with an autonomous secretion of adrenal hormones, often secondary to a tumor (either mono- or bi-lateral, or not always in the adrenals). Their diagnosis could be challenging, especially in patients with hypertension as the first (and/or isolated) clinical manifestation. Moreover, they are all rare form of hypertension, therefore a correct screening with a sensitive test is mandatory, to refer quickly the patients to an Endocrine Unit. In this short review we pinpoint our attention to these adrenal-related secondary form of hypertension, describing in a concise way their first-line screening procedures.

Keywords: Cushing syndrome; Hypertension; Pheochromocytoma; Primary aldosteronism.