HYPERTENSIVE CRISIS IN ENDOCRINE AND RENAL DISORDERS: PATHOPHYSIOLOGY, CLINICAL MANIFESTATIONS, AND EVIDENCE-BASED MANAGEMENT

Hypertensive crisis represents a critical medical emergency characterized by severe blood pressure elevation (systolic ≥180 mmHg and/or diastolic ≥120 mmHg) with potential for acute target-organ damage. While essential hypertension accounts for approximately 95% of cases, secondary causes—particularly endocrine and renal disorders—contribute significantly to hypertensive emergencies and are potentially curable with timely intervention. Endocrine causes including pheochromocytoma, Cushing's syndrome, and primary aldosteronism account for nearly 3% of secondary hypertension cases, whereas renovascular and renoparenchymal diseases represent major non-endocrine secondary etiologies. This comprehensive narrative review examines the pathophysiological mechanisms linking endocrine and renal disorders to hypertensive crisis, delineates clinical manifestations and diagnostic approaches, and synthesizes current evidence-based management strategies. Understanding the interplay between hormonal dysregulation, renin-angiotensin-aldosterone system activation, and renal dysfunction is essential for clinicians to recognize secondary causes, initiate targeted therapy, and prevent life-threatening complications including stroke, myocardial infarction, and acute renal failure.