What Is Endocrine Hypertension?

Endocrine hypertension is high blood pressure (hypertension) caused by underlying hormonal imbalances or conditions affecting the endocrine system. The endocrine system is a complex network of glands that produce and release hormones that regulate various bodily functions, including metabolism, growth, stress response, and blood pressure.
When there is a disruption in the normal hormonal balance within the endocrine system, it can lead to hypertension. The endocrine system includes glands such as the adrenal, thyroid, pituitary, and others, all producing hormones that can influence blood pressure regulation.

What Are the Causes of Endocrine Hypertension?

Endocrine hypertension can result from different conditions, including:

Primary Aldosteronism

This condition is where the adrenal glands produce too much aldosterone, a hormone that helps regulate salt and fluid balance. Excess aldosterone can lead to high blood pressure.

Cushing's Syndrome

In Cushing’s syndrome, the body produces too much cortisol, often due to an overactive adrenal gland or the prolonged use of corticosteroid medications. Elevated cortisol levels can contribute to hypertension.


An overactive thyroid gland can lead to high levels of thyroid hormones, which can affect the heart and blood vessels, potentially causing hypertension.


This rare adrenal gland tumour can lead to the overproduction of adrenaline and noradrenaline, hormones that can raise blood pressure.


Excess growth hormone production, often due to a pituitary gland tumour, can lead to an enlarged heart and increased blood pressure.

What Are Some Common Symptoms of Endocrine Hypertension?

Endocrine hypertension, which is high blood pressure caused by hormonal imbalances in the endocrine system, can have various symptoms. The symptoms can vary depending on the underlying hormonal disorder causing the hypertension. Here are some common symptoms that may be associated with endocrine hypertension:

High Blood Pressure

The primary symptom of endocrine hypertension is elevated blood pressure. However, high blood pressure might not always cause noticeable symptoms, so regular checkups are important for early detection.


Some people with endocrine hypertension may experience frequent headaches, especially if blood pressure is significantly elevated.

Heart Palpitations

You might feel your heart racing or fluttering in your chest due to the effects of hormones on the heart and blood vessels.


Excessive sweating, especially when not triggered by heat or physical activity, can occur due to hormonal fluctuations.

Fatigue and Weakness

Hormonal imbalances can affect energy levels and lead to feelings of tiredness and weakness.

Nervousness or Anxiety

Some individuals may experience heightened feelings of nervousness or anxiety as a result of hormonal changes.

Weight Changes

Unintended weight gain or loss can occur due to hormone-related disruptions in metabolism.

Changes in Appetite

Hormonal imbalances can affect appetite, leading to increased or decreased hunger.

Tremors or Shaking

Tremors or shaking of the hands or other body parts can sometimes be linked to hormonal disorders.

Muscle Weakness

Weakness in muscles can result from hormonal disturbances affecting muscle function.

Vision Changes

In some cases, hormonal imbalances might lead to blurred vision or other vision changes.

Irregular Heartbeat

Hormonal effects on the heart can cause irregular heartbeats, known as arrhythmias.

Skin Changes

Certain hormonal conditions can lead to skin changes such as acne, thickening, or darkening.

Increased Thirst and Urination

Hormonal imbalances can affect fluid balance, leading to increased thirst and urination.

How Is Endocrine Hypertension Diagnosed?

Diagnosing endocrine hypertension involves a series of medical assessments, tests, and evaluations to determine the underlying hormonal imbalance causing high blood pressure. A comprehensive diagnostic approach is essential because various endocrine disorders can contribute to hypertension. Here’s an overview of the diagnostic process:

Medical History and Physical Examination

Your healthcare specialist will gather information about your medical history, symptoms, family history of hypertension or endocrine disorders, and any medications you take. They will also conduct a physical examination, including measuring blood pressure.

Blood Pressure Monitoring

Accurate and consistent blood pressure measurements are a crucial part of diagnosis. Blood pressure readings will be taken at different times and possibly over multiple days to assess their variability.

Blood Tests

Blood tests will be performed to measure hormone levels contributing to hypertension. Depending on the suspected underlying condition, common hormones measured include aldosterone, renin, cortisol, thyroid hormones, and others.

Urine Tests

Urine tests may be conducted to assess hormone levels and their metabolites. This can provide valuable information about adrenal and kidney function.

Imaging Studies

Imaging techniques, such as CT or MRI scans, may be used to visualise the adrenal glands, thyroid gland, or other relevant structures to detect abnormalities, tumours, or nodules.

Functional Imaging

Specialised scans, such as an MIBG scan or adrenal venous sampling, may be conducted to localise the source of hormone overproduction in conditions like pheochromocytoma or primary aldosteronism.

Thyroid Function Tests

Testing the levels of thyroid hormones and thyroid-stimulating hormone (TSH) can help identify thyroid-related causes of hypertension.

What Are the Health Complications of an Untreated Endocrine Hypertension?

Untreated endocrine hypertension, which is high blood pressure caused by hormonal imbalances in the endocrine system, can lead to serious health complications. Managing and treating the underlying hormonal disorders causing hypertension is important to prevent these potential complications. Here are some of the health risks associated with untreated endocrine hypertension:

Cardiovascular Disease

Chronic high blood pressure significantly increases the risk of cardiovascular diseases such as heart attack, stroke, and heart failure. The strain on the heart and blood vessels can damage these organs over time.

Kidney Damage

High blood pressure can damage the small blood vessels in the kidneys, reducing their ability to filter waste and excess fluids from the body. This can lead to kidney dysfunction or even kidney failure.

Damage to Blood Vessels

Persistent high blood pressure can cause damage to the walls of blood vessels, leading to atherosclerosis (narrowing and hardening of arteries) and increasing the risk of blood clots, aneurysms, and other vascular complications.

Vision Problems

Hypertension can damage the blood vessels in the eyes, potentially leading to vision problems and even blindness.

Heart Rhythm Abnormalities

Untreated high blood pressure can disrupt the electrical signals that control the heartbeat, leading to arrhythmias (irregular heartbeats) and an increased risk of heart-related complications.

Heart Enlargement

The heart may enlarge in response to the increased workload caused by hypertension, which can weaken the heart muscle and impair its function.

Metabolic Syndrome

Untreated high blood pressure is often associated with other metabolic abnormalities, such as obesity, high cholesterol, and insulin resistance, collectively known as metabolic syndrome. Metabolic syndrome increases the risk of diabetes and cardiovascular diseases.

End-Organ Damage

Over time, untreated hypertension can damage various organs throughout the body, including the brain, heart, kidneys, and eyes.


High blood pressure is a leading risk factor for stroke, which occurs when blood flow to the brain is blocked or disrupted.

Cognitive Impairment

Hypertension can contribute to cognitive decline and an increased risk of dementia and Alzheimer’s disease.

Pregnancy Complications

Untreated high blood pressure during pregnancy (preeclampsia) can pose serious risks to both the mother and baby, including premature birth, low birth weight, and eclampsia (seizures).

Emotional and Psychological Impact

Chronic hypertension can contribute to stress, anxiety, and reduced quality of life.

What Are the Different Treatment Options for Endocrine Hypertension?

The treatment of endocrine hypertension involves addressing the underlying hormonal imbalance that is causing high blood pressure. The approach to treatment will depend on the specific endocrine disorder involved. Here are some common treatment options for different types of endocrine hypertension:

Primary Aldosteronism

  • Surgery: Surgical removal of the adrenal gland tumour may be recommended
  • Medications: Aldosterone receptor blockers (spironolactone or eplerenone) are often used to reduce the effects of excess aldosterone in those who are not suitable to undergo surgery.

Cushing's Syndrome

  • If caused by prolonged use of corticosteroid medications, gradual tapering of these medications under medical supervision is necessary.
  • Surgery: In cases of adrenal tumours causing Cushing’s syndrome, surgical removal of the tumour (adrenalectomy) may be considered.
  • Medication: Medical options can be considered for those who are not suitable for surgery


  • Antithyroid Medications: Medications like methimazole or propylthiouracil may be prescribed to regulate thyroid hormone production.
  • Radioactive Iodine Therapy: Radioactive iodine can be used to reduce the activity of an overactive thyroid gland.
  • Thyroidectomy: Surgical removal of all or part of the thyroid gland may be recommended in certain cases.


  • Surgery: The tumour causing excess adrenaline and noradrenaline production is usually surgically removed.


Medications may be used to reduce growth hormone production (somatostatin analogues) or block its effects (growth hormone receptor antagonists).
  • Surgery: Removing the pituitary tumour causing acromegaly may be necessary.

Regular Monitoring

  • Ongoing medical monitoring is essential to adjust treatment, assess blood pressure, and manage any potential side effects of medications.

Dr. Cho Li Wei 朱丽薇医生

Consultant Endocrinologist
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