ABSTRACT
Hypertension is a common clinical abnormality in the Western world. Even though its precise etiology remains to be elucidated, it can be effectively managed in most patients with lifestyle changes, such as exercise and weight control, either alone or in conjunction with a variety of pharmacological agents, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and beta-adrenergic antagonists. In contrast, surgically correctable forms of hypertension are infrequently encountered in clinical practice. Two diseases of the adrenal gland exhibiting abnormal aldosterone and catecholamine production and a number of renal artery occlusive lesions associated with excess renin-angiotensin activity, often present clinically with blood pressure elevations. Several other endocrine diseases, including hyperthyroidism, pituitary-dependent Cushing’s disease, ectopic adrenocorticotropin (ACTH) production by pancreatic tumors, and reninomas can all cause hypertension, however, they are very rare. Similarly, renal artery occlusions and secondary hypertension due to emboli and dissections are quite uncommon. Contemporary practice requires a thorough understanding of the more common correctable forms of hypertension associated with adrenal and renal diseases. An understanding of these abnormalities is the focus of this chapter. For a more comprehensive discussion of adrenal gland physiology and pathophysiology, the reader is referred to the chapter on that subject.
