Endocrine causes of high blood pressure

Over a quarter of the global population is affected by hypertension – or high blood pressure. This is the leading cause of heart attacks and strokes.

10% of these people are in a subgroup of people who are affected by what is called “secondary hypertension”. This is high blood pressure brought about by other conditions negatively affecting the kidneys, heart, arteries or endocrine system.

It is the latter – medical conditions which affect hormone levels - which I would like to cover in more detail.

We know the following endocrine conditions can cause high blood pressure and these are often detected when hypertension does not respond to the usual medication. This is known as having “resistant hypertension” and should be suspected especially in those who are younger and without any family history of early onset hypertension.

Cushing’s syndrome

Cushing’s syndrome describes the condition whereby people are found to have had high blood levels of cortisol over a long period of time.

This most commonly occurs in women aged 25 to 45 and is usually caused by a benign pituitary tumour – or occasionally tumours - on the adrenal glands.

Cortisol stimulates the kidney’s reabsorption of sodium and this in turn increases the sensitivity to catecholamine and angiotensin II which can then lead to high blood pressure.

High aldosterone levels (hyperaldosteronism)

These are common and often unrecognised contributors to high blood pressure. When adrenal glands produce an excess of the hormone “aldosterone” it makes the kidneys retain an excess of salt and water and lose too much potassium - which then causes hypertension.

This can be primary as a result of secretion from benign nodules within the adrenal glands (Conn’s syndrome) or secondary due to kidney disease such as renal artery stenosis where there is narrowing of the arteries that supply the kidneys.

Acromegaly 

Acromegaly is a rare condition typically diagnosed in people aged between 40 and 45 years. It is caused by a benign tumour of the pituitary gland producing an excess of growth hormone.

High blood pressure is seen in almost a third of those with acromegaly. Although the reason for this has not been fully explained we do know that it is probably caused by a combination of an increase in the volume of extracellular fluid and peripheral vascular resistance.

Obstructive sleep apnoea is common in those with acromegaly and this can also result in raised blood pressure.

Phaeochromocytomas

These are rare neuroendocrine tumours which are usually present in adrenal glands. About 80% grow in the inner layer of the glands and 20% outside the adrenal glands.

This can lead to episodic spikes in blood pressure or long-term hypertension. This occurs because the condition produces high levels of catecholamines which act on the cardiovascular system resulting in an increased heart rate, blood flow and blood pressure.

Hyperthyroidism

When the thyroid gland produces too much thyroid hormone (an overactive thyroid), high blood pressure can result.  This is because the heart is forced to work harder than usual which raises the heart rate and lowers vascular resistance.

Hyperparathyroidism

It is the role of parathyroid glands to control the levels of calcium and phosphorus in the body. If these glands produce an excess of calcium - due to hyperparathyroidism – this can trigger a rise in blood pressure.

This is because excess calcium causes an increase in vascular resistance – which slows blood flow through blood vessels

I hope this has been helpful.

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