Differential Diagnosis for Hypertensive with Hypokalaemia
Single Most Likely Diagnosis
- Primary Aldosteronism: This condition is characterized by the excessive production of aldosterone, leading to hypertension and hypokalemia due to the mineralocorticoid effect of aldosterone, which promotes potassium excretion in the urine.
Other Likely Diagnoses
- Renal Artery Stenosis: This condition can lead to secondary aldosteronism due to activation of the renin-angiotensin-aldosterone system (RAAS), resulting in hypertension and hypokalemia.
- Cushing's Syndrome: Excess cortisol can have a mineralocorticoid effect, leading to hypertension and hypokalemia, although this is less common than the glucocorticoid effects.
- Liddle's Syndrome: A rare genetic disorder but considered here due to its direct relation to the symptoms, characterized by excessive sodium absorption and potassium secretion in the distal nephron, leading to hypertension and hypokalemia.
Do Not Miss Diagnoses
- Phaeochromocytoma with Secondary Aldosteronism: Although less common, a pheochromocytoma can occasionally lead to secondary aldosteronism, and missing this diagnosis could be catastrophic due to the potential for severe hypertensive crises.
- Licorice Abuse or Ingestion: Glycyrrhizin in licorice can inhibit 11-beta hydroxysteroid dehydrogenase, leading to an apparent mineralocorticoid excess syndrome, characterized by hypertension and hypokalemia.
Rare Diagnoses
- Apparent Mineralocorticoid Excess (AME): A rare genetic disorder affecting the metabolism of cortisol, leading it to act as a potent mineralocorticoid, resulting in hypertension and hypokalemia.
- 17-alpha Hydroxylase Deficiency: A rare congenital adrenal hyperplasia that leads to an overproduction of mineralocorticoids and underproduction of sex hormones, causing hypertension and hypokalemia.
- Glucocorticoid-Remediable Aldosteronism: A rare form of primary aldosteronism that is responsive to glucocorticoid suppression, leading to hypertension and hypokalemia due to excessive aldosterone production.