Other kidney disorders Some
renal tumors can cause hypertension. The
differential diagnosis of a renal tumor in a young patient with hypertension includes
juxtaglomerular cell tumor,
Wilms' tumor, and
renal cell carcinoma, all of which may produce renin. •
Renal segmental hypoplasia (Ask-Upmark kidney)
Other endocrine disorders • Neurogenic hypertension – excessive secretion of norepinephrine and epinephrine which promotes
vasoconstriction resulting from chronic high activity of the
sympathoadrenal system, the
sympathetic nervous system and the
adrenal gland. The specific mechanism involved is increased release of the "stress hormones",
epinephrine (adrenaline) and
norepinephrine which increase blood output from the heart and constrict arteries. People with neurogenic hypertension respond poorly to treatment with diuretics as the underlying cause of their hypertension is not addressed. •
Pheochromocytoma – a tumor that results in an excessive secretion of norepinephrine and epinephrine, which promotes vasoconstriction. •
Hyperparathyroidism •
Acromegaly Adrenal A variety of adrenal cortical abnormalities can cause hypertension, In primary
aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.
Congenital adrenal hyperplasia, a group of autosomal recessive disorders of the enzymes responsible for steroid hormone production, can lead to secondary hypertension by creating atypically high levels of
mineralocorticoid steroid hormones. These mineralocorticoids cross-react with the aldosterone receptor, activating it and raising blood pressure. •
17 alpha-hydroxylase deficiency causes an inability to produce cortisol. Instead, extremely high levels of the precursor hormone corticosterone are produced, some of which is converted to
11-Deoxycorticosterone (DOC), a potent mineralocorticoid not normally clinically important in humans. DOC has blood-pressure raising effects similar to aldosterone, and abnormally high levels result in
hypokalemic hypertension. •
11β-hydroxylase deficiency, aka
apparent mineralocorticoid excess syndrome, involves a defect in the gene for
11β-hydroxysteroid dehydrogenase, an enzyme that normally inactivates circulating
cortisol to the less-active metabolite
cortisone. At high concentrations
cortisol can cross-react and activate the
mineralocorticoid receptor, leading to
aldosterone-like effects in the
kidney, causing hypertension. This effect can also be produced by prolonged ingestion of
liquorice (which can be of potent strength in
liquorice candy), by causing inhibition of the
11β-hydroxysteroid dehydrogenase enzyme and likewise leading to secondary
apparent mineralocorticoid excess syndrome. Frequently, if liquorice is the cause of the high blood pressure, a low blood level of potassium will also be present. Yet another related disorder causing hypertension is
glucocorticoid remediable aldosteronism, which is an
autosomal dominant disorder in which the increase in
aldosterone secretion produced by
ACTH is no longer transient, causing of
primary hyperaldosteronism, the
Gene mutated will result in an
aldosterone synthase that is
ACTH-sensitive, which is normally not.
GRA appears to be the most common
monogenic form of human hypertension. Compare these effects to those seen in
Conn's disease, an
adrenocortical tumor which causes excess release of aldosterone, that leads to hypertension. Another adrenal related cause is
Cushing's syndrome which is a disorder caused by high levels of
cortisol. Cortisol is a
hormone secreted by the
cortex of the
adrenal glands. Cushing's syndrome can be caused by taking
glucocorticoid drugs, or by tumors that produce cortisol or
adrenocorticotropic hormone (ACTH). More than 80% of patients with Cushing's syndrome develop hypertension., which is accompanied by distinct symptoms of the syndrome, such as
central obesity,
lipodystrophy,
moon face,
sweating,
hirsutism and
anxiety.
Neuroendocrine tumors are also a well known cause of secondary hypertension.
Pheochromocytoma (most often located in the
adrenal medulla) increases secretion of
catecholamines such as
epinephrine and
norepinephrine, causing excessive stimulation of
adrenergic receptors, which results in peripheral
vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their
metabolites (
vanillylmandelic acid).
Other sleep disturbances Another cause is an exceptionally rare
neurological disease called
Binswanger's disease, causing
dementia; it is a rare form of
multi-infarct dementia, and is one of the neurological
syndromes associated with hypertension.
Arsenic exposure Because of the ubiquity of arsenic in ground water supplies and its effect on cardiovascular health, low dose
arsenic poisoning should be inferred as a part of the pathogenesis of idiopathic hypertension. Idiopathic and essential are both somewhat synonymous with primary hypertension. Arsenic exposure has also many of the same signs of primary hypertension such as
headache,
somnolence,
confusion,
proteinuria,
visual disturbances, and
nausea and
vomiting.
Potassium deficiency Due to the role of intracellular potassium in regulation of cellular pressures related to sodium, establishing potassium balance has been shown to reverse hypertension.
Other causes of secondary hypertension •
Hormonal contraceptives •
Neurologic disorders •
Liquorice (when consumed in excessive amounts) •
Scleroderma •
Neurofibromatosis •
Pregnancy: unclear cause. •
Cancers: tumours in the kidney can operate in the same way as kidney disease. More commonly, however, tumors cause inessential hypertension by ectopic secretion of hormones involved in normal physiological control of blood pressure. •
Drugs: • Heavy
alcohol use •
NSAIDs •
MAOIs,
SNRIs, and
TCA antidepressants • Combined methods of
hormonal contraception (those containing
ethinylestradiol) •
Steroid use •
Nicotine use ==Diagnosis==