Differential Diagnosis for Hypertension in a 16-year-old Boy with Neurofibromatosis

• Single most likely diagnosis
  • A) Catecholamine-producing tumor: This is the most likely cause of hypertension in this patient. Neurofibromatosis type 1 (NF1) is associated with an increased risk of developing pheochromocytomas, which are catecholamine-producing tumors. The patient's symptoms of headaches and pallor, along with his family history of NF1, support this diagnosis.
• Other Likely diagnoses
  • E) Postsubclavian coarctation of the aorta: Although less common, coarctation of the aorta can be associated with NF1. However, the absence of murmurs and equal radial pulses make this diagnosis less likely.
  • D) Overproduction of aldosterone from an adrenal adenoma: This condition can cause hypertension, but it is not as strongly associated with NF1 as pheochromocytoma.
• Do Not Miss diagnoses
  • None of the options provided are classic "do not miss" diagnoses that are unlikely but potentially deadly if missed. However, it's essential to consider other potential causes of hypertension in the differential diagnosis, such as renal disease or hyperthyroidism, even if they are not listed among the options.
• Rare diagnoses
  • B) Carcinoma of the thyroid gland: Thyroid carcinoma is rare in adolescents, and there is no specific association with NF1 that would make this a likely cause of hypertension in this patient.
  • C) Essential hypertension: Although essential hypertension is a common cause of high blood pressure in the general population, it is less likely in a patient with a known genetic disorder like NF1 and symptoms suggestive of a secondary cause of hypertension.