Differential Diagnosis for Secondary Hypertension in an 18-year-old Man

Single Most Likely Diagnosis

• Renal disease (e.g., renal artery stenosis, glomerulonephritis): This is a common cause of secondary hypertension in young individuals. The patient's age and lack of other symptoms make a renal cause a plausible explanation for his elevated blood pressure.

Other Likely Diagnoses

• Pheochromocytoma: Although rare, this condition can cause episodic or sustained hypertension and is more common in younger individuals. The patient's lack of symptoms such as palpitations, sweating, or headaches does not rule out this diagnosis.
• Primary aldosteronism: This condition, characterized by excessive aldosterone production, can lead to hypertension and hypokalemia. The patient's age and blood pressure elevation make this a possible diagnosis.
• Coarctation of the aorta: This congenital condition can cause hypertension in young individuals, particularly if it is undiagnosed. However, it often presents with other symptoms such as leg claudication or diminished lower extremity pulses.

Do Not Miss Diagnoses

• Cushing's syndrome: This rare endocrine disorder can cause hypertension, among other symptoms. Although the patient appears well-developed and well-nourished, Cushing's syndrome can be subtle in its presentation, and missing this diagnosis could have significant consequences.
• Hyperthyroidism: Uncontrolled hyperthyroidism can lead to hypertension, and although the patient's heart rate is normal, this condition can sometimes present with a normal heart rate, especially in younger individuals.
• Sleep apnea: Although less common in young, healthy individuals, sleep apnea can cause secondary hypertension. The patient's lack of reported symptoms such as daytime somnolence does not rule out this diagnosis.

Rare Diagnoses

• Congenital adrenal hyperplasia: This group of genetic disorders can lead to hypertension due to excessive production of mineralocorticoids. The patient's age and presentation make this a less likely but possible diagnosis.
• Thyroid storm: A rare and life-threatening condition that can cause hypertension, among other symptoms. Although the patient's vital signs are relatively stable, this condition can sometimes present subtly, especially in its early stages.
• Paraganglioma: A rare neuroendocrine tumor that can cause hypertension due to excessive catecholamine production. The patient's lack of symptoms such as palpitations or sweating does not rule out this diagnosis.