Endocrine arterial hypertension: diagnostic approach in clinical practice

Area of Science:

• Endocrinology
• Hypertension Research
• Diagnostic Medicine

Background:

• Endocrine arterial hypertension (EAH), caused by hormone excess, is a rare but increasingly diagnosed form of hypertension.
• Improved diagnostic techniques have led to a rise in EAH prevalence.
• Current clinical practice involves hormonal screening for renin-aldosterone, catecholamine, and glucocorticoid excess in hypertensive patients.

Purpose of the Study:

• To review current understanding for earlier recognition of main EAH forms.
• To discuss screening laboratory methods and localization techniques for EAH diagnosis.
• To enhance clinicians' ability to diagnose EAH.

Main Methods:

• Review of current literature on EAH diagnosis.
• Discussion of screening tests: aldosterone-to-renin ratio (ARR) for primary aldosteronism (PA), 24-hour urinary free cortisol and dexamethasone suppression test for Cushing's syndrome (CS).
• Description of localization techniques: CT, MRI, and scintigraphy for adrenal and catecholamine-producing neoplasms.

Main Results:

• Primary aldosteronism (PA) is the most frequent cause of EAH, screened by ARR and confirmed with suppression tests.
• Cushing's syndrome (CS) diagnosis relies on urinary free cortisol and dexamethasone suppression tests, with CT/MRI for localization.
• Urinary metanephrine levels are key for diagnosing catecholamine-producing tumors, located via CT, MRI, or scintigraphy.

Conclusions:

• Earlier recognition of EAH is facilitated by understanding specific endocrine causes like PA, CS, and catecholamine excess.
• Advanced screening and localization techniques significantly improve diagnostic accuracy for EAH.
• This review provides clinicians with updated knowledge for effective EAH diagnosis and management.