Adrenal endocrine hypertension due to primary aldosteronism, pheochromocytoma, and Cushing's syndrome presents with distinct clinical profiles, and HTN remission after specific treatment remains incomplete across all three etiologies.
Key Findings
Methods
The study cohort of 55 subjects was predominantly composed of primary aldosteronism cases, with a slight female preponderance and an average age of 47 years.
Primary aldosteronism accounted for 52.8% of cases, pheochromocytoma for 29.1%, and ACTH-independent Cushing's syndrome for 18.1%.
Female patients comprised 60% of the total cohort.
The average age of participants was 47.0 ± 14.9 years.
First-degree family history of hypertension was described in up to two thirds of cases.
This was a retrospective observational descriptive study conducted at a tertiary referral center.
Results
Patients with primary aldosteronism presented at a significantly younger age at diagnosis and demonstrated a more severe and resistant hypertension profile requiring a higher number of antihypertensive drugs.
PA patients had significantly younger age at HTN diagnosis compared to the other two groups.
HTN in PA was characterized as more severe and resistant.
PA patients required a higher number of antihypertensive drugs than patients with PHEO or CS.
HTN-mediated organ damage (HMOD) was mainly cardiovascular and ocular across the cohort.
Results
Patients with pheochromocytoma were significantly older at diagnosis and had more severe and paroxysmal hypertension.
PHEO patients were significantly older at diagnosis compared to PA and CS patients.
Hypertension in PHEO was characterized as both more severe and paroxysmal in nature.
All subjects with PHEO were operated on with adrenalectomy.
HTN remission was observed in 37.5% of PHEO cases following adrenalectomy.
Results
Patients with ACTH-independent Cushing's syndrome had less severe hypertension and less hypertension-mediated organ damage compared to the other groups.
CS patients had less severe HTN relative to PA and PHEO patients.
HMOD was less prevalent in CS patients.
CS patients were surgically managed in 50% of cases.
HTN remission was achieved in 40% of surgically treated CS cases.
Results
HTN remission rates after specific treatment were low across all three adrenal etiologies, with primary aldosteronism showing the lowest surgical remission rate.
PA patients were treated medically with mineralocorticoid receptor antagonists in 72.4% of cases.
HTN remission was achieved in only 21.8% of PA patients after surgical treatment.
PHEO patients achieved HTN remission in 37.5% of cases after adrenalectomy.
CS patients achieved HTN remission in 40% of cases after surgical management.
Specific treatments were indicated in all cases aiming at complete remission of HTN.
Conclusions
Early screening for adrenal endocrine hypertension is considered crucial for prevention of cardiovascular morbidity.
The authors conclude that diagnosis and management of adrenal endocrine HTN diseases are 'challenging for healthcare professionals.'
Endocrine etiologies of secondary hypertension are described as 'frequent and increasingly diagnosed according to the learned societies.'
Hypertension-mediated organ damage was predominantly cardiovascular and ocular across the cohort.
The study highlights the incomplete remission rates across all etiologies as a key clinical challenge.
What This Means
This research examined 55 patients with high blood pressure caused by three different adrenal gland disorders: primary aldosteronism (overproduction of a salt-regulating hormone), pheochromocytoma (a tumor that releases adrenaline-like hormones), and Cushing's syndrome (overproduction of cortisol). The study found that each condition causes a distinct pattern of high blood pressure: primary aldosteronism tended to cause earlier-onset, harder-to-control blood pressure requiring multiple medications; pheochromocytoma caused severe, episodic spikes in blood pressure in older patients; and Cushing's syndrome caused milder blood pressure elevation with less damage to organs like the heart and eyes.
Despite treatments targeting the underlying cause — including surgery and medications — blood pressure did not fully normalize in the majority of patients. The cure rates for high blood pressure after treatment were notably low: only about 22% for primary aldosteronism after surgery, 37.5% for pheochromocytoma after tumor removal, and 40% for Cushing's syndrome after surgical intervention. This suggests that even when the root hormonal cause is addressed, blood pressure abnormalities often persist, possibly due to long-term vascular changes.
This research suggests that adrenal gland disorders are an underappreciated but important cause of difficult-to-treat high blood pressure, and that identifying these conditions early may help prevent heart and organ damage. Healthcare providers may benefit from screening for hormonal causes of hypertension, particularly in patients whose blood pressure is hard to control with standard medications. The findings also highlight that blood pressure management may need to continue even after successful treatment of the underlying hormonal disorder.
Bayar I, Sayadi H, Ayachi F, Amor B, Abid S, Hajji E, et al.. (2026). Clinical course and management of adrenal endocrine hypertension: A single-center experience.. Endocrine regulations. https://doi.org/10.2478/enr-2026-0023