Differential Diagnosis for 19 YOM with Hypertension and Presyncope

Single Most Likely Diagnosis

• Essential Hypertension: This is the most common cause of hypertension in young adults, and the patient's home blood pressure readings are significantly elevated. However, the discrepancy between home and triage blood pressure readings suggests potential white coat hypertension or variability in blood pressure measurements.

Other Likely Diagnoses

• White Coat Hypertension: The significant difference between the patient's home blood pressure readings and the triage reading suggests the possibility of white coat hypertension, where anxiety in a clinical setting causes elevated blood pressure readings.
• Anxiety or Stress-Related Hypertension: Episodes of presyncope could be related to anxiety or stress, which can cause transient increases in blood pressure.
• Orthostatic Hypotension: Although the patient presents with hypertension, episodes of presyncope could indicate orthostatic hypotension, especially if the patient experiences a drop in blood pressure upon standing.

Do Not Miss Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and symptoms like presyncope due to catecholamine surges. It's crucial to rule out this condition due to its potential for severe complications if left untreated.
• Hyperthyroidism: Can cause hypertension and symptoms like palpitations, tremors, and potentially presyncope due to increased sympathetic activity.
• Coarctation of the Aorta: A congenital condition characterized by narrowing of the aortic isthmus, which can lead to hypertension and might cause presyncope due to reduced blood flow to the lower body.

Rare Diagnoses

• Renal Artery Stenosis: A narrowing of the arteries that supply blood to the kidneys, which can cause secondary hypertension.
• Cushing's Syndrome: A rare endocrine disorder caused by excess cortisol, which can lead to hypertension among other symptoms.
• Primary Aldosteronism: Excess production of aldosterone leading to hypertension and potentially hypokalemia.
• Thyroid Crisis: A life-threatening condition that represents an extreme exacerbation of hyperthyroidism symptoms, including severe hypertension and potential for presyncope or syncope.

Each of these diagnoses should be considered and investigated based on the patient's clinical presentation, history, and physical examination findings, with particular emphasis on ruling out the "Do Not Miss" diagnoses due to their potential for severe consequences if not promptly identified and treated.