Acute Adrenal Hypertensive Emergencies: Pheochromocytoma, Cushing’s, Hyperaldosteronism

Hypertensive emergency is defined as a rapid and significant elevation of blood pressure with systolic blood pressure greater than 180 mm Hg and/or diastolic blood pressure greater than 120 mm Hg in association with evidence of neurologic, cardiovascular, renal, and other end organ damage. Hypertensive emergencies due to endocrine and metabolic conditions rather than more common essential hypertension are seen in less than 5% of cases, but, when present, can be the cause of severe morbidity and mortality. Prompt recognition is important to initiate targeted therapy and avoid life-threatening complications such as stoke and myocardial infarction. The most common adrenal endocrine conditions that can cause hypertensive emergencies include pheochromocytoma/paraganglioma syndrome (PPGL), primary hyperaldosteronism, Cushing’s syndrome, and Cushing’s disease. This chapter describes the clinical presentation, best diagnostic tests, and up-to-date management of acute adrenal hypertensive emergencies.