Endocrine hypertension

Hypertension may be caused by abnormal synthesis of, or response to, various hormones. The proportion of pediatric hypertension cases resulting from such problems probably represents at most a few percent of cases overall, but a higher fraction of cases of severe hypertension, those occurring in the very young, or cases clustering in families. Most endocrine hypertension involves the adrenal gland and its hormones. The adrenal gland is composed of two endocrine tissues: the medulla (secreting catecholamines) and the cortex (synthesizing cortisol and aldosterone). Pheochromocytoma is mainly a disease of the adrenal medulla, although extramedullary sites may be involved. Many different diseases affecting the adrenal cortex can cause hypertension. These include hypertensive forms of congenital adrenal hyperplasia, primary aldosteronism due to hyperplasia of the zona glomerulosa or to adenomas, and Cushing’s syndrome (excessive glucocorticoid exposure) due to iatrogenic etiologies, to pituitary or adrenal adenomas, or to other tumors secreting excessive ACTH. Hypertension can also be caused by thyrotoxicosis due to Graves’ disease or to the thyrotoxic phase of Hashimoto’s thyroiditis. It is important to accurately diagnose these disorders because the associated hypertension requires, and usually responds well to, specific treatment of the underlying hormonal abnormality.