Endocrine secondary hypertension

The need to evaluate patients for secondary hypertension is common in clinical practice. Suspicion of endocrine hypertension occurs when the disease starts suddenly at young age, in cases with loss of blood pressure control in a patient with previously well-controlled blood pressure or labile blood pressure cases. Careful medical history and physical examination are very important to rule out other factors responsible for these patterns of hypertension (certain medications, alcohol, lack of compliance to treatment or dietary salt restriction, panic attacks etc). Pheochromocytoma and Cushing syndrome – the major endocrine diseases associated with secondary hypertension – are rare in clinical practice. Instead, primary hyperaldosteronism is becoming more frequently identified. It can go unnoticed because of nonspecific clinical presentation and of the fact that hypokalaemia, classically described, is actually rare in practice.