Approach to Secondary Hypertension due to endocrine causes

Approach to Secondary Hypertension due to endocrine causes

This powerpoint comprises of approachment of secondary hypertension mainly due to endocrine causes

1. APPROACH TO SECONDARY HYPERTENSION DUE TO ENDOCRINE CAUSES Durgesh K 30.09.2025

2. INTRODUCTION “Hypertension should be defined in the terms of blood pressure level above which investigation and treatment do good more than harm.” American College of Cardiology/American Heart Association (ACC/AHA) Criteria 1.A 24-hour mean of 125/75 mm Hg or above
2.Daytime (awake) mean of 130/80 mm Hg or above
3.Nighttime (asleep) mean of 110/65 mm Hg or above

3. Classification

4. Hypertension can be primary (90–95%) or secondary (5–10%)

5. Endocrine causes are important because many are curable Failure to identify leads to resistant HTN and complications Early diagnosis improves outcomes

6. When to Suspect Secondary HTN Onset <30 years or >55 years Resistant HTN (>3 drugs including diuretic) Sudden worsening of BP HTN with electrolyte imbalance (e.g., hypokalemia) Paroxysmal symptoms (headache, palpitations, sweating) Features of endocrine dysfunction Family history of endocrine tumors

7. Endocrine Causes Overview Primary hyperaldosteronism Pheochromocytoma / Paraganglioma Cushing Syndrome Thyroid disorders Hyperparathyroidism Acromegaly

8. Primary Hyperaldosteronism Excess aldosterone → sodium retention & potassium loss → HTN HTN with hypokalemia Screening: Aldosterone-to-Renin Ratio (ARR) Confirm: Saline suppression, oral sodium loading Imaging: CT/MRI Treatment: Surgery or mineralocorticoid antagonists

9. Pheochromocytoma Catecholamine-secreting tumor Triad: headache, sweating, palpitations ± paroxysmal HTN Labs: Plasma/urine metanephrines Imaging: CT/MRI, MIBG scan Treatment: α-blockade → β-blockade → surgery

10. Cushing Syndrome Causes: ACTH-dependent or independent Features: central obesity, moon face, purple striae, HTN Screen: DST, urinary cortisol, salivary cortisol Treatment: Surgery or medications (ketoconazole, metyrapone)

11. Thyroid Disorders Hyperthyroidism: ↑ cardiac output, ↓ SVR Hypothyroidism: ↑ peripheral resistance, diastolic HTN Labs: TSH, T3, T4 Treatment: antithyroid drugs or levothyroxine

12. Hyperparathyroidism Hypercalcemia → vascular stiffness, renal effects → HTN Features: stones, bone pain, GI symptoms Dx: ↑Calcium, ↑PTH, ↓phosphate Treatment: Parathyroidectomy

13. Acromegaly GH-secreting pituitary adenoma Features: enlarged hands/feet, coarse facies, HTN Dx: IGF-1, OGTT, MRI pituitary Treatment: Surgery ± octreotide/pegvisomant

14. Diagnostic Algorithm Step 1: Suspect based on history + exam Step 2: Basic labs (electrolytes, glucose, TSH) Step 3: Specific hormonal tests Step 4: Targeted imaging Step 5: Treat underlying cause

15. Management Principles Address root endocrine pathology Use antihypertensives as needed Surgery for adenomas/tumors Hormonal therapy where applicable Monitor electrolytes, BP, recurrence

16. Case Illustrations HTN + hypokalemia → Primary aldosteronism Episodic HTN + headaches → Pheochromocytoma Cushingoid features + resistant HTN → Cushing syndrome

17. Summary Endocrine HTN = uncommon but reversible Clinical suspicion is key Targeted hormonal workup Definitive treatment improves outcomes

18. QUESTIONS Q1. Secondary hypertension with hypokalemia is strongly suggestive of:

A. Hypothyroidism
B. Primary hyperparathyroidism
C. Primary hyperaldosteronism D. Addison’s disease

19. ✅ Answer: C. Primary hyperaldosteronism

20. Q2. A 42-year-old man presents with episodes of severe headache, palpitations, sweating, and anxiety. His blood pressure spikes to 200/110 mmHg during attacks but is normal in between episodes.

Which investigation is most appropriate initially?

A. Plasma renin activity
B. 24-hour urinary metanephrines C. Serum aldosterone levels
D. Low-dose dexamethasone suppression test

21. ✅ Answer: B. 24-hour urinary metanephrines

22. Q3.A 55-year-old man presents with persistent hypertension, fatigue, and depression. Lab shows:

TSH: 0.01 μIU /mL (low)

Free T4: high

Pulse is 112/min

What type of hypertension is expected in this patient?

A. Diastolic only
B. Malignant
C. Systolic predominantly
D. Normotensive with tachycardia

23. ✅ Answer: C. Systolic predominantly