Skip to main content

Advertisement

Log in

Adrenocortical hypertension

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Primary aldosteronism, congenital adrenal hyperplasia, Cushing’s syndrome, glucocorticoid-remediable aldosteronism, and corticotropin-dependent forms of adrenal pathology can cause hypertension by excessive production of adrenocortical hormones. Although traditional biochemical assays continue to be used, genetic testing has simplified the diagnosis of glucocorticoid-remediable aldosteronism. Also new interventional radiologic approaches for the diagnosis and treatment of corticotropin-dependent forms of Cushing’s syndrome are available. Medical and surgical approaches, however, still remain viable options for treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Young MJ, Funder JW: Mineralocorticoid receptors and pathophysiological roles for aldosterone in the cardiovascular system. J Hypertens 2002, 20:1465–1468.

    Article  PubMed  CAS  Google Scholar 

  2. Thakar RB, Oparil S: Primary aldosteronism: a practical approach to diagnosis and treatment. J Clin Hypertens 2001, 3:189–195. The authors provide a comprehensive overview of diagnosis and treatment of primary aldosteronism.

    Article  Google Scholar 

  3. Stowasser M, Gordon RD: Primary aldosteronism: from genesis to genetics. Trends Endocrinol Metab 2003, 14:310–317. This is an informative view of the epidemiology, diagnostic techniques, and especially pioneering work into the genetics of familial aldosteronism, types 1 and 2.

    Article  PubMed  CAS  Google Scholar 

  4. Prejbisz A, Postula M, Cybulska I, et al.: The role of biochemical tests and clinical symptoms in the differential diagnosis of primary aldosteronism. Kardil Pol 2003, 58:17–26.

    Google Scholar 

  5. Rayner BL: Screening and diagnosis of primary aldosteronism. Cardiovasc J S Afr 2002, 13:166–170.

    PubMed  Google Scholar 

  6. Nussberger J: Investigating mineralocorticoid hypertension. J Hypertens Suppl 2003, 21(Suppl 2):S25-S30.

    PubMed  CAS  Google Scholar 

  7. Nadar S, Lip GY, Beevers DG: Primary hyperaldosteronism. Ann Clin Biochem 2003, 40(Pt 5):439–452. This article provides an in-depth understanding of the value of the screening and the value of the aldosterone to PR A ratio for screening.

    Article  PubMed  CAS  Google Scholar 

  8. McKenna TJ, Sequiera SJ, Heffeman A, et al.: Diagnosis under random conditions of all disorders of reninangiotensin-aldosterone axis, including primary hyperaldosteronism. J Clin Endocrin Metab 1991, 73:952–957.

    CAS  Google Scholar 

  9. Gordon RD, Tunny TJ: Aldosterone-producing adenoma effect of pregnancy. Clin Exp Hypertens Theory Pract 1982, A4:1685–1693.

    Google Scholar 

  10. Murphy BF, Whitworth JA, Kincaid-Smith P: Malignant hypertension due to an aldosterone producing adrenal adenoma. Clin Exp Hypertens Pract 1958, A7:939–950.

    Article  Google Scholar 

  11. Rossi E, Regolisti G, Negro A, et al.: High prevalence of primary aldosteronism using post-captopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives. Am J Hypertens 2002, 15(10 Pt 1):896–902.

    Article  PubMed  CAS  Google Scholar 

  12. Gulla N, Patriti A, Fabbri B, et al.: Surgical technique and haemodynamic changes in adrenalectomy for secreting neoplasia: personal experience and review of the literature. Minerva Chir 2003, 58:87–92.

    PubMed  CAS  Google Scholar 

  13. O’Boyle CJ, Kapadia CR, Sedman PC, et al.: Laparoscopic transperitoneal adrenalectomy. Surg Endosc 2003, 17:1905–1909.

    Article  PubMed  CAS  Google Scholar 

  14. Ghose RP, Hall PM, Bravo EL: Medical management of aldosterone-producing adenomas. Ann Intern Med 1999, 131:105–108.

    PubMed  CAS  Google Scholar 

  15. Bravo EL: Medical management of primary hyperaldosteronism. Curr Hypertens Rep 2001, 3:406–409.

    Article  PubMed  CAS  Google Scholar 

  16. Mulatero P, Veglio F, Pilon C, et al.: Diagnosis of glucocorticoid-remediable aldosteronism in primary aldosteronism: aldosterone response to dexamethasone and long polymerase chain reaction for chimeric gene. J Clin Endocrinol Metab 1998, 83:2573–2575. The authors confirm the value of polymerase chain reaction for the diagnosis of glucocorticoid-remediable aldosteronism.

    Article  PubMed  CAS  Google Scholar 

  17. Enberg U, Volpe C, Hamberger B: New aspects on primary aldosteronism. Neurochem Res 2003, 28:327–332.

    Article  PubMed  CAS  Google Scholar 

  18. Bravo EL: Aldosterone and specific aldosterone receptor antagonists in hypertension and cardiovascular disease. Curr Hypertens Rep 2003, 5:122–125.

    Article  PubMed  Google Scholar 

  19. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.

    Article  PubMed  CAS  Google Scholar 

  20. Pitt B, Remme WJ, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321. The investigators discuss the action of eplerenone on cardiovascular tissue and its benefits, noting the absence of antiandrogenic side effects of eplerenone.

    Article  PubMed  CAS  Google Scholar 

  21. Hokotate H, Inoue H, Baba Y, et al.: Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases. Radiology 2003, 227:401–406.

    Article  PubMed  Google Scholar 

  22. White PC: Inherited forms of mineralocorticoid hypertension. Hypertension 1996, 28:927–936.

    Google Scholar 

  23. Rosler A, Leiverman E, Cohen T: High frequency of congenital adrenal hyperplastic (classic 11 beta-hydroxylase deficiency) among Jews from Morrocco. Am J Med Genet 1992, 42:827–834.

    Article  PubMed  CAS  Google Scholar 

  24. Oberfield SE, Levine LS, New MI: Childhood hypertension due to adrenocortical disorders. Pediatr Ann 1982, 11:623–626.

    PubMed  CAS  Google Scholar 

  25. Ghazi AA, Hadayegh F, Khakpour G, et al.: Bilateral testicular enlargement due to adrenal remnant in a patient with C11 hydroxylase deficiency congenital adrenal hyperplasia. J Endocrinol Invest 2003, 26:84–87.

    PubMed  CAS  Google Scholar 

  26. Biglieri EG, Herron MA, Brust N: 17 alpha-hydroxylation in man. J Clin Invest 1966, 45:1946–1954.

    PubMed  CAS  Google Scholar 

  27. Kershnar AK, Borut D, Kogut MD, et al.: Studies in a phenotypic female with 17 alpha-hydroxylase deficiency. J Pediatr 1976, 89:395–400.

    Article  PubMed  CAS  Google Scholar 

  28. Peter M: Congenital adrenal hyperplasia: 11beta-hydroxylase deficiency. Semin Reprod Med 2002, 20:249–254. The author reviews the importance of 11β-hydroxylase deficiency, with mention of the role of genetic resting.

    Article  PubMed  CAS  Google Scholar 

  29. Cerame BI, Newfield RS, Pascoe L, et al.: Prenatal diagnosis and treatment of 11beta-hydroxylase deficiency congenital adrenal hyperplasia resulting in normal female genitalia. J Clin Endocrinol Metab 1999, 84:3129–3134.

    Article  PubMed  CAS  Google Scholar 

  30. New MI: Prenatal treatment of congenital adrenal hyperplasia: the United States experience. Endocrinol Metab Clin North Am 2001, 30:1–13. The author discusses prenatal diagnosis and its implications regarding genital ambiguity, genital surgery, sex misassignment, or confusion

    Article  PubMed  CAS  Google Scholar 

  31. Chabre O, Portrat-Doyen S, Chaffanjon P, et al.: Bilateral laparoscopic adrenalectomy for congenital adrenal hyperplasia with severe hypertension, resulting from two novel mutations in splice donor sites of CYP11B1. J Clin Endocrinol Metab 2000, 85:4060–4068.

    Article  PubMed  CAS  Google Scholar 

  32. Teran Davila J, Teppa-Garran AD: Polycystic ovary syndrome of extra-ovarian origin [review]. Invest Clin 2001, 42:51–78.

    Google Scholar 

  33. Opocher G, Rocco S, Carpene G, et al.: Differential diagnosis in primar y aldosteronism. J Steroid Biochem Mol Biol 1993, 45:49–55.

    Article  PubMed  CAS  Google Scholar 

  34. Ross EJ, Linch DC: Cushing’s syndrome—killing disease. Discriminating value of signs and symptoms aiding early diagnosis. Lancet 1983, 2:646–649.

    Google Scholar 

  35. White PC: 11 beta-hydroxysteroid dehydrogenase and its role in the syndrome of apparent mineralocorticoid excess. Am J Med Sci 2001, 322:308–315. A discussion of the pathophysiolgy of this deficiency and its relationship to cortisol excess in hypertension.

    Article  PubMed  CAS  Google Scholar 

  36. Ulick S, Wang JZ, Blumenfeld JD, et al.: Cortisol inactivation overload: a mechanism of mineralocorticoid hypertension in ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 1992, 74:963–967.

    Article  PubMed  CAS  Google Scholar 

  37. Blunt SB, Sandler LM, Burrin JM, et al.: Pituitary ACTHdependent Cushing’s syndrome by clinical features, biochemical tests, and radiological findings. Q J Med 1990, 77:1113–1133.

    PubMed  CAS  Google Scholar 

  38. Yakota N, Bruneau BG, Kuroski deBold ML, et al.: Atrial natiuretic factor significantly contributes to the mineralocorticoid escape phenomenon: evidence for a guanylate cyclase-mediated pathway pathway. J Clin Invest 1994, 94:1938–1946.

    Article  Google Scholar 

  39. Faggiano A, Pivonello R, Spiezia S, et al.: Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 2003, 88:2527–2533. This article describes the relationship between Cushing’s syndrome and metabolic syndrome, vascular damage, and atherosclerosis, and its response to treatment.

    Article  PubMed  CAS  Google Scholar 

  40. Di Somma C, Pivonello R, Loche S, et al.: Effect of 2 years of cortisol normalization on the impaired bone mass and turnover in adolescent and adult patients with Cushing’s disease: a prospective study. Clin Endocrinol 2003, 58:302–308. The authors document the response of bone mass and biochemical markers of bone turnover to successful treatment of Cushing’s disease as well as its clinical significance in regard to additional treatments for low bone density.

    Article  Google Scholar 

  41. Nieman LK: Medical therapy of Cushing’s disease. Pituitary 2002, 5:77–82.

    Article  PubMed  CAS  Google Scholar 

  42. Miner JN, Tyree C, Hu J, et al.: A nonsteroidal glucocorticoid receptor antagonist. Mol Endocrinol 2003, 17:117–127.

    Article  PubMed  CAS  Google Scholar 

  43. Kelly PA, Samandouras G, Grossman AB, et al.: Neurosurgical treatment of Nelson’s syndrome. J Clin Endocrinol Metab 2002, 87:5465–5469.

    Article  PubMed  CAS  Google Scholar 

  44. Flitsch J, Knappe UJ, Ludecke DK: The use of postoperative ACTH levels as a marker for successful transsphenoidal microsurgery in Cushing’s disease. Zentralbl Neurochir 2003, 64:6–11.

    Article  PubMed  CAS  Google Scholar 

  45. Malumoud-Ahmed AS, Suh JH: Radiation therapy for Cushing’s disease: a review. Pituitary 2002, 5:175–180. A concise discussion of the various radiation therapies for Cushing’s disease that is unresponsive to conventional therapy.

    Article  Google Scholar 

  46. Degerblad M, Brismar K, Rahn T, et al.: The hypothalamuspituitary function after pituitary stereotactic radiosurgery: evaluation of growth hormone deficiency. J Intern Med 2003, 253:454–462.

    Article  PubMed  CAS  Google Scholar 

  47. Isidori AM, Kaltsas GA, Mohammed S, et al.: Discriminatory value of the low-dose dexamethasone suppression test in establishing the diagnosis and differential diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 2003, 88:5299–5306.

    Article  PubMed  CAS  Google Scholar 

  48. Reimondo G, Paccotti P, Minetto M, et al.: The corticotrophin-releasing hormone test is the most reliable noninvasive method to differentiate pituitary from ectopic ACTH secretion in Cushing’s syndrome. Clin Endocrinol 2003, 58:718–724.

    Article  CAS  Google Scholar 

  49. Loli P, Vignati F, Grossrubatscher E, et al.: Management of occult adrenocorticotropin-secreting bronchial carcinoids: limits of endocrine testing and imaging techniques. J Clin Endocrinol Metab 2003, 88:1029–1035.

    Article  PubMed  CAS  Google Scholar 

  50. Lifton R, Dluhy R, Powers M, et al.: A chimeric 11beta-hydrox ylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature 1992, 355:262–265.

    Article  PubMed  CAS  Google Scholar 

  51. Dluhy R, Lifton R: Glucocorticoid-remediable aldosteronism. J Clin Endocrin Metab 1999, 84:4341–4344. The investigators who first delineated the molecular genetics of glucocorticoid-remediable aldosteronism provide a general overview of the topic.

    Article  CAS  Google Scholar 

  52. Rich GM, Ulick S, Cook S, et al.: Glucocorticoid-remediable aldosteronism in a large kindred: clinical spectrum and diagnosis using a characteristic biochemical phenotype. Ann Intern Med 1992, 116:813–820.

    PubMed  CAS  Google Scholar 

  53. Litchfield WR, Anderson BF, Weiss RJ, et al.: Intracranial aneurysm and hemorrhagic stroke in glucocorticoidremediable aldosteronism. Hypertension 1998, 31:445–450.

    PubMed  CAS  Google Scholar 

  54. Litchfield WR, New MI, Coolidge C, et al.: Evaluation of the dexamethasone suppression test for the diagnosis of glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab 1997, 82:3570–3573.

    Article  PubMed  CAS  Google Scholar 

  55. Slaton PE Jr, Schambelan M, Biglieri EG: Stimulation and suppression of aldosterone secretion in patients with an aldosterone-producing adenoma. J Clin Endocrinol Metab 1969, 29:239–250.

    Article  PubMed  CAS  Google Scholar 

  56. Weber KT: Aldosterone in congestive heart failure. N Engl J Med 2001, 345:1689–1697. The author performed the original studies in experimental animals, and demonstrated the pathophysiologic role of aldosterone on the cardiovascular system. Heart failure is discussed in a historical context.

    Article  PubMed  CAS  Google Scholar 

  57. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717. This landmark clinical trial was designed with the basic science information on the pathophysiologic role of aldosterone in mind. It describes the effects of aldosterone blockade in older persons with heart failure.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nathaniel Winer MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Capricchione, A., Winer, N. & Sowers, J.R. Adrenocortical hypertension. Curr Urol Rep 7, 73–79 (2006). https://doi.org/10.1007/s11934-006-0045-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-006-0045-6

Keywords

Navigation