The immediate management and investigation of an acute endocrine presentation in general practice is discussed in this section. It is inspired by, but not based on, real patient situations.
Most patients presenting with hypertension have essential hypertension with contributing factors including age, increased body mass index, high dietary sodium and alcohol consumption. A minority develop hypertension secondary to other causes. These include medications (e.g. oral contraceptive pill, NSAIDs, nasal decongestants) and comorbidities such as renal disease, obstructive sleep apnoea and aortic coarctation. Several endocrine disorders, including primary hyperaldosteronism, phaeochromocytoma and paraganglioma (PPGL) and Cushing’s syndrome, should also be considered in the work-up of hypertension. In this review of three cases, we discuss the variable presentation of PPGL in general practice and when to investigate further.