Endocrine hypertension: An overview on the current etiopathogenesis and management options

Table 1 Key clinical features, screening and confirmatory tests, radiological and management modalities for primary aldosteronism and pheochromocytoma

	Primary aldosteronism	Pheochromocytoma
Clinical features	Difficult to control HTN
Common Symptoms	on 3 or more hypertensive agents	Episodes or paroxysmal hypertension
		Headache
	Young age of onset of HTN	Sweating
		Palpitations
Signs	With or without hypokalemia
	Asymptomatic vs Symptomatic	Hypertension
	Muscle weakness, cramping, headaches, palpitations, and polyuria	Tachycardia
		Orthostatic hypotension
		Heart failure
Screening tests	AM plasma aldosterone to renin ratio > 30	24-h urine fractionated metanephrines
	+/- Aldosterone > 20 ng/dL	Plasma fractionated metanephrines (high suspicion)
Confirmatory tests	Oral sodium loading test with 24 h aldosterone level > 12 μg/24 h	Same as above
	Saline infusion test
	Fludrocortisone suppression test
	Captopril challenge test
Radiology	Adrenal protocol CT	Adrenal protocol CT/MRI
	+/- Scintigraphy	123I-MIBG scan/111In-pentetreotide/FDG-PET
	Adrenal vein sampling
Treatment	For bilateral disease (or for those with unilateral disease who are unable to undergo surgery)	Pre-op preparation (10-14 d prior to surgery)
Medical		Phenoxybenzamine
	Spirinolactone (best choice)	Alpha-blockers blockers-Doxazocin, Prazocin or Terazocin
	Eplerenone	Calcium channel blockers
	Amiloride	Beta-blockers
		Metyrosine
Surgical	For unilateral source of aldosteronism:	Laparoscopic/retro-peritoneal adrenalectomy of adrenal pheochromocytoma
	Laparoscopic adrenalectomy

CT: Computed tomography; MRI: Magnetic resonance imaging; FDG-PET: Fluorodeoxyglueose-positron emission tomography.