Differential Diagnosis for Hypertension in a 52-year-old Female with DM and Knee Osteoarthritis

• Single most likely diagnosis
  • b. NSAID-induced HTN: The patient has been using NSAIDs for knee osteoarthritis, and NSAIDs are known to cause hypertension by inhibiting prostaglandin synthesis, leading to renal vasoconstriction and sodium retention. The low potassium level (hypokalemia) could also be related to the use of NSAIDs, which can lead to hyperaldosteronism or increased sodium reabsorption.
• Other Likely diagnoses
  • a. Essential HTN: This is a common condition, and given the patient's age and presence of diabetes mellitus, essential hypertension is a plausible diagnosis. However, the recent development of hypertension in the context of NSAID use makes essential hypertension less likely as the primary cause in this scenario.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • d. Primary hyperaldosteronism: Although less common, primary hyperaldosteronism can cause hypertension and hypokalemia. It is crucial to consider this diagnosis because it has a specific treatment (e.g., spironolactone) and can lead to significant morbidity if left untreated.
• Rare diagnoses
  • c. Pheochromocytoma: This is a rare tumor of the adrenal gland that can cause episodic or sustained hypertension. While it is less likely given the patient's presentation and the absence of other typical symptoms (e.g., palpitations, sweating, headaches), it is a diagnosis that should not be missed due to its potential for severe consequences if untreated. However, the lack of specific symptoms and the context of NSAID use make this a less probable cause in this case.