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Adrenal causes of hypertension are:
1) Excess of aldosterone production in primary aldosteronism. The diagnosis may be suspected when persistent hypokalemia is detected. Most often a CT scan of the adrenals will identify the presence of an adenoma or hyperplasia.
2) Excess cortisol levels in cushing's syndrome. This syndrome is suspected in patients with truncal obesity, thin skin and weakness. The diagnosis can be arrived at by measuring 24 hour urinary cortisol or by doing dexamethasone suppression test.
3) Hypertension caused by increased catecholamines is found in Pheochromocytoma, which usually is found in the adrenal medulla. The striking feature in this condition is the marked fluctuations in blood pressure. The associated symptoms are spells of headache, sweating, palpitations, nervousness, nausea and tremors. These symptoms could be mistaken for anxiety and as postmenopausal syndrome. The diagnostic tests are 24 hour urinary metanephrine estimation and CT and MRI scans of the adrenals.
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