Table 3.

Other Endocrine Causes of Secondary Hypertension

Disorder	Major Clinical Findings	Physical Examination	Screening Tests	Additional/Confirmatory Tests
Hypothyroidism	Dry skin; cold intolerance; constipation; hoarseness; weight gain	Delayed ankle reflex; periorbital puffiness; coarse skin; cold skin; slow movement; goiter	High TSH; low or normal fT4
Hyperthyroidism	Warm, moist skin; heat intolerance; nervousness; tremulousness; insomnia; weight loss; diarrhea; proximal muscle weakness	Lid lag; fine tremor of the outstretched hands; warm, moist skin	Low TSH; high or normal fT4 and T3	Radioactive iodine uptake and scan
Hypercalcemia and primary hyperparathyroidism	Hypercalcemia	Usually none	Serum calcium	Serum parathyroid hormone
Congenital adrenal hyperplasia (excess DOC)	Hypertension and hypokalemia; virilization (11-β-OH deficiency); incomplete masculinization in males and primary amenorrhea in females (17-α-OH deficiency)	Signs of virilization (11β) or incomplete masculinization (17α)	Hypertension and hypokalemia with low or normal aldosterone and renin	11-β-OH: elevated DOC, 11-deoxycortisol and androgens; 17-α-OH: decreased androgens and estrogen; elevated DOC and corticosterone
Other mineralocorticoid excess syndromes caused by DOC	Early-onset hypertension, hypokalemia	Arrhythmias (with hypokalemia)	Low aldosterone and renin	DOC; urinary cortisol metabolites; genetic testing
Acromegaly	Acral features; enlarging shoe, glove, or hat size; headache; visual disturbances; diabetes mellitus	Acral features; large hands and feet; frontal bossing	Serum growth hormone ≥1 ng/mL during oral glucose load	Elevated age- and sex-matched IGF-1 level; MRI scan of the pituitary

DOC indicates deoxycorticosterone; fT4, free thyroxine; IGF-1, insulin-like growth factor-1; MRI, magnetic resonance imaging; OH, hydroxylase; T3, triiodothyronine; and TSH, thyroid-stimulating hormone.