Endocrine hypertension: the role of imaging in diagnosis and management

Endocrine hypertension is an uncommon but treatable cause of secondary hypertension. It results from excessive hormone production by the endocrine glands or due to ectopic hormone production. The causes of abnormal hormonal production can be congenital or acquired. Specific syndromes can also predispose to the development of endocrine hypertension. Extensive catecholamine production can occur due to pheochromocytomas and paragangliomas (PPGLs). Excessive aldosterone secretion by the adrenal cortex commonly occurs due to idiopathic (bilateral) adrenal hyperplasia or aldosterone-producing adrenal adenomas. Excessive cortisol production can occur secondary to abnormalities in the adrenal gland, the pituitary gland, or ectopic hormone production, or it can be caused by exogenous steroid intake. Other endocrine conditions that can lead to hypertension include acromegaly, primary hyperparathyroidism, hyperthyroidism, and hypothyroidism. Imaging plays a vital role in diagnosing the cause of endocrine hypertension, leading to appropriate management. The clinical presentation and laboratory investigations serve as a guide to the appropriate imaging investigation that needs to be performed to confirm a diagnosis.