Pathophysiology of adrenal hypertension

Hypertension affects 20% to 25% of the adult population. Most patients are diagnosed as having essential or primary hypertension. Up to 10% to 15% have an identifiable cause and many of those have an adrenal basis. The identification of an adrenal cause of hypertension provides an opportunity for a targeted therapeutic intervention. Mineralocorticoid hypertension refers to hypertension caused by increased sodium and water retention by the kidney, expansion of the extracellular fluid compartment, and direct effects on the vasculature and circumventricular areas of the central nervous system (CNS), which result in elevation of blood pressure. The most common form of mineralocorticoid hypertension (MCH) is primary hyperaldosteronism (PA). In the past decade, significant advances have been made in our understanding of the pathogenesis of low-renin hypertension with the elucidation of the genetic basis and characterization of 3 forms of monogenic hypertension: glucocorticoid-remediable aldosteronism, syndrome of apparent mineralocorticoid excess, and Liddle's syndrome. This article focuses attention on the role of steroid hormones in the pathogenesis of hypertension and outlines the pathophysiology of the different forms of adrenal hypertension.