Endocrine hypotension: A highly prevalent and often curable disease, yet underdiagnosed.

Introduction

Have you ever realised that the diagnosis of endocrine hypertension is often delayed or never even made? What do you think are the possible reasons for these missing diagnoses?

Discussion

Almost 1.28 billion adults aged 30-79 years worldwide suffer from hypertension and nearly 82% of them live in low-income and middle-income countries. Up to 10% of the hypertensive population (around 128 million) has endocrine hypertension, mostly from primary aldosteronism. The prevalence figures of endocrine hypertension are double in patients with resistant hypertension and triple in those with moderate to severe obstructive sleep apnoea. Estimates of the global prevalence of endocrine hypertension is often inaccurate due to wide variations in the approach to diagnostic workup, inadequate awareness among physicians, and the resource limitations for appropriate investigations in many population groups.

Whom should be investigated for endocrine hypertension?

• Patients with early onset hypertension before 30 years of age.
• Patients with resistant hypertension, requiring 3 or more blood pressure lowering drugs.
• Patients with hypertensive urgency, emergency, or recent deterioration of blood pressure control.
• Patients with strong family history of hypertension.
• Patients with symptoms suggestive of endocrine hypertension:
  • Muscle weakness or cramps, (primary aldosteronism)
  • Paroxysmal headaches, sweating and palpitations (pheochromocytoma)
  • Symptoms of thyroid illness, acromegaly, or Cushing’s syndrome,
  • Snoring or excessive daytime sleepiness (obstructive sleep apnoea)
  • Flash pulmonary edema (renal artery stenosis)
• Patients with incidentally detected adrenal adenoma.

What benefits can an accurate diagnosis of endocrine hypertension offer to the patients?

• Cure of hypertension or at least improvement in blood pressure control and quality of life
• Reduction in pill burden, morbidity and even mortality
• Considerable comfort and relief from a psychological point of view
• Opportunity for genetic testing of family members and genetic counselling

What our textbook offers to the readers.

• Contains excellent basic science chapters explaining the pathobiological aspects of endocrine hypertension.
• Elaboration of individual causes of endocrine hypertension (clinical picture, diagnostic evaluation, and management algorithms).
• Illustration of various imaging modalities used in work-up of endocrine hypertension.
• Written by the global experts in the field of endocrine hypertension from 12 different countries across 5 continents. Several of our authors attributed to the discovery of various diseases and/or the associated genes implicated in the etiology of endocrine hypertension.
• Valuable resource and reference guide to physicians, cardiologists, endocrinologists or to anyone involved in the management of hypertension including paediatricians, obstetricians, and primary care providers.

Conclusion

Increasing the knowledge and awareness of endocrine hypertension among clinicians can increase the chance of accurate diagnoses and management of patients with this common clinical problem. This shall also help to reduce the global morbidity and mortality from hypertension. 

About the Editors

Professor Joseph M Pappachan MD, FRCP, Lancashire Teaching Hospitals NHS Trust, UK; and Manchester Metropolitan University, UK. Joseph M Pappachan (0000-0003-0886-5255) (orcid.org)

Dr. Cornelius J Fernandez MD, MSc, MRCP, Pilgrim Hospital, Boston, The United Lincolnshire Hospitals NHS Trust, UK. Cornelius Fernandez James (0000-0002-1171-5525) (orcid.org)

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