Differential Diagnosis for Hypertension in a 12-Year-Old Boy

Single Most Likely Diagnosis

• Pheochromocytoma: This is a rare tumor of the adrenal gland that can cause episodic hypertension, headaches, palpitations, and sweating due to excessive catecholamine release. The symptoms and significant hypertension in this patient make pheochromocytoma a leading consideration.

Other Likely Diagnoses

• Essential Hypertension: Although less common in children, essential hypertension can occur and should be considered, especially with a family history of hypertension. However, the severity of hypertension and associated symptoms in this case make it less likely.
• Renal Parenchymal Disease: Conditions such as chronic kidney disease or glomerulonephritis can cause hypertension. Normal renal functions and urinalysis reduce the likelihood but do not rule out certain renal diseases.
• Coarctation of the Aorta: A congenital condition characterized by narrowing of the aorta, which can lead to hypertension. The absence of other typical findings (e.g., delayed or diminished pulses in the lower extremities) makes this less likely.

Do Not Miss Diagnoses

• Hyperthyroidism: Can cause hypertension, palpitations, and sweating. Although the symptoms can overlap, hyperthyroidism is a critical diagnosis not to miss due to its potential for serious complications if untreated.
• Adrenal Cortical Tumors or Hyperplasia (Cushing's Syndrome): These conditions can lead to hypertension and other systemic symptoms. Early diagnosis is crucial due to the potential for significant morbidity.
• Vasculitis (e.g., Takayasu Arteritis): A form of large vessel vasculitis that can cause hypertension among other symptoms. It is rare but critical to diagnose due to its potential for severe complications.

Rare Diagnoses

• Neuroblastoma: A childhood cancer that can cause hypertension due to compression or catecholamine secretion. It is rare and typically presents with a mass or other systemic symptoms.
• Familial Dysautonomia (Riley-Day Syndrome): A rare genetic disorder that affects the development of the autonomic nervous system and can lead to episodes of hypertension among other symptoms.
• Pseudohypoaldosteronism Type 2 (Gordon Syndrome): A rare genetic disorder leading to hypertension and hyperkalemia due to renal resistance to mineralocorticoids. The normal serum electrolytes in this case make this less likely.