High Blood Pressure and Hormones

A form of secondary hypertension - that is, a hypertension with a known cause - is hormone-induced hypertension. Here, an over- or underproduction of various hormones leads to high blood pressure values.

The most important forms are:

pheochromocytoma, which is the cause in about 0.2 to 0.4 percent of all hypertension cases,
Cushing's syndrome - this accounts for about 0.3 percent of hypertension patients, and
Conn's syndrome, which constitutes about 12 percent of hormone-induced hypertension.
Hyperthyroidism/Hypothyroidism (see separate article)

Pheochromocytoma

Pheochromocytoma is usually a benign tumor of the adrenal medulla. In some cases, it occurs as an extra-adrenal pheochromocytoma (paraganglioma) outside the adrenal gland near the spine or major blood vessels and originates from a part of the autonomic nervous system that runs along the spine (sympathetic trunk). Its occurrence is considered rare (there are two to eight new cases per year for every million people). It leads to an overproduction of catecholamines such as adrenaline, noradrenaline, and dopamine, which also cause the symptoms that may occur. High blood pressure occurs in most patients either persistently or in paroxysms. Additionally, there may be pounding headaches, sweating, palpitations, and pallor.

Cushing's Syndrome

Cushing's syndrome is characterized by an abnormally increased production of cortisol, an adrenal hormone. Usually, a benign tumor in the pituitary gland (hypophysis) is the cause. This results in an overproduction of the hormone ACTH, which in turn stimulates adrenal hormone production and leads to increased cortisol secretion.

In rarer cases, tumors in the adrenal gland produce too much cortisol directly. This influences the blood pressure regulation of the kidney and can lead to hypertension. Additionally, there may be a deficiency of potassium, which can lead to circulatory dysfunction. Other important consequences of hormone overproduction include the so-called moon face, truncal obesity, stretch marks on the skin (striae), onset of diabetes, muscle wasting, susceptibility to infections, depressive moods, and more.

Conn's Syndrome

Conn's syndrome - also referred to as primary hyperaldosteronism - is one of the most common causes of secondary hypertension. It is a disease of the adrenal glands that causes an overproduction of the hormone aldosterone. Aldosterone is significantly involved in the regulation of water and salt in the body. Through its effect on salt transport, aldosterone leads to the excretion of potassium and the reabsorption of sodium salt and water. This means that too little salt is excreted, and the resulting increased fluid volume in the vascular system leads to elevated blood pressure.

There are two different causes that lead to this condition: On one hand, the adrenal glands may be enlarged (bilateral adrenal cortical hyperplasia) and therefore produce too much aldosterone. On the other hand, there are benign tumors (adenomas) in the adrenal gland that also produce aldosterone and increase its levels. The first cause is somewhat more common, accounting for about 60% of all Conn's syndromes. It can often be treated well with medication. In both cases, Conn's syndrome is considered well treatable, and in the case of surgery, even curable.

In addition, there are some other, but very rare causes for the development of Conn's syndrome. However, if left untreated, Conn's syndrome often leads to severe complications and organ damage. The blood pressure resulting from the syndrome leads to significantly more frequent and severe consequences than in other forms of hypertension.

High Blood Pressure in Menopause

The development of high blood pressure in women during menopause also has a hormonal background. Here, it is not an overproduction that is the cause, but rather a decrease in the production of the hormone estrogen. Until menopause, this has a protective effect as it lowers blood pressure. However, estrogen production decreases during menopause, and the protective effect is lost. In contrast, the level of the male hormone testosterone increases. This now promotes the development of abdominal fat in women - just as in men - which can in turn release appetite-stimulating hormones and thus also increase blood pressure. Women can best counteract this with plenty of exercise, a healthy and low-salt diet, low alcohol consumption, and avoiding nicotine.

The ESH (European Society of Hypertension) has included an early onset of menopause, meaning the absence of menstruation before the age of 45 without it being explainable by treatment, as a risk factor for developing hypertension. Affected women are advised to regularly monitor their blood pressure and, if high values are measured, to start treatment as soon as possible to prevent complications.
Regular monitoring is also recommended if hormone replacement therapy is being carried out during menopause. The therapy does not necessarily have to increase blood pressure, but it is possible that this occurs. Therefore, monitoring, possibly medication for hypertension treatment, and if blood pressure cannot be lowered, discontinuation of hormone replacement therapy (of course only in consultation with the treating physician) is advised.

Hormone Therapies
If transgender individuals undergo gender-affirming hormone therapy, where hormones must be dosed significantly higher than, for example, in hormone replacement therapy during menopause, they are also advised to monitor their blood pressure. Currently, the data is not yet conclusive as to whether the therapy increases the risk of developing hypertension or other cardiovascular diseases. However, it is recommended to monitor blood pressure values as a precaution.
This also applies to hormone therapies that take place for other reasons.

Acromegaly

Acromegaly is a condition caused by an increased secretion of growth hormones due to a slowly growing tumor of the pituitary gland (hypophysis). The noticeable feature is the enlargement of the acral parts of the body (i.e., the ends of the body) - such as fingers, toes, nose, chin, and cheekbones. If the condition develops before the completion of height growth, it results in an unusually large body size. However, the proportions remain intact. Acromegaly not only leads to excessive growth but also to an increase in blood volume due to reduced water and sodium excretion. This can result in hypertension.

Sources

By Sabine Croci. This article is medically reviewed. Last updated (04/2024).
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