Table 1. Diagnostic and treatment considerations for endocrine hypertension in pregnancy.

	Primary Aldosteronism	Cushing syndrome	Pheochromocytoma
Best diagnostic approach	Plasma aldosterone and renin measurement	Late-night salivary cortisol followed by ACTH and MRI for localization	24-h urine or plasma metanephrines followed by MRI for localization
Caveats for diagnosis in pregnancy	Confirmatory testing and AVS not recommended	DST is unreliable due to elevated cortisol, ACTH and CBG	Medications and physiologic stress may elevate catecholamines
	Elevated aldosterone may be normal	Salivary cortisol and ACTH levels may be elevated in normal pregnancy	Radionuclide imaging for localization is contra-indicated in normal pregnancy
	Renin may not be completely suppressed due to secretion by placenta and uterus	IPSS is not recommended for evaluation of CD
Treatment	Medical management with amiloride	Surgery prior to 24th week gestation	Surgery prior to 24th week gestation
	If hypertension uncontrolled and nodule present, may consider laparoscopic adrenalectomy	Medical management with metyrapone if pre-surgical treatment is necessary or surgery is not possible	Presurgical preparation includes alpha-blockade followed by beta-blockade

ACTH, adrenocorticotropic hormone; AVS, adrenal vein sampling; CBG, corticosteroid-binding globulin; CD, Cushing disease.