Differential Diagnosis for Secondary Hypertension in an 18-year-old
Single most likely diagnosis
- Renal disease (e.g., chronic kidney disease, glomerulonephritis, or renal vascular disease): This is a common cause of secondary hypertension in young adults, and kidney problems can often be asymptomatic until hypertension develops.
Other Likely diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension, often accompanied by other symptoms like headaches, palpitations, and sweating.
- Primary aldosteronism: A condition where the adrenal gland produces too much aldosterone, leading to hypertension and hypokalemia (low potassium levels).
- Coarctation of the aorta: A congenital condition where the aorta is narrowed, leading to high blood pressure in the arms and low blood pressure in the legs.
- Sleep apnea: A condition where breathing stops and starts during sleep, leading to intermittent hypoxia and increased blood pressure.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Aortic dissection: A life-threatening condition where the aorta tears, leading to severe chest pain and potentially fatal complications if not treated promptly.
- Pregnancy-related hypertension: Although less likely in an 18-year-old male, it's essential to consider pregnancy-related hypertension in female patients, as it can be a life-threatening condition for both the mother and the fetus.
- Cushing's syndrome: A rare condition where the body produces too much cortisol, leading to hypertension, weight gain, and other symptoms.
Rare diagnoses
- Hyperthyroidism: An overactive thyroid gland can cause hypertension, although it's a less common cause of secondary hypertension.
- Hyperparathyroidism: A condition where the parathyroid gland produces too much parathyroid hormone, leading to hypercalcemia (high calcium levels) and potentially hypertension.
- Vasculitis: Inflammation of the blood vessels, which can cause hypertension and other symptoms like fever, fatigue, and weight loss.
- Neurogenic hypertension: A condition where hypertension is caused by a neurological disorder, such as a brain tumor or spinal cord injury.