Differential Diagnosis for Hypertension in a 13-year-old Boy
Single Most Likely Diagnosis
- D) Glucocorticoid excess: The patient's symptoms, including hypertension, rounded facies, purple striae over the abdomen, hips, and thighs, and glucose in the urine, are highly suggestive of Cushing's syndrome, which is caused by excess glucocorticoids. This condition can lead to hypertension, weight gain (particularly in the central part of the body), and glucose intolerance.
Other Likely Diagnoses
- B) Catecholamine excess: This condition, often associated with pheochromocytoma, can cause hypertension. However, it typically presents with episodic hypertension, headaches, sweating, and tachycardia, which are not mentioned in the scenario.
- E) Insulin deficiency: While insulin deficiency (diabetes mellitus type 1) can lead to glucose in the urine, it does not directly cause hypertension in the absence of renal complications. The presence of hypertension and other symptoms suggests a different primary diagnosis.
- OF) Insulin excess: Insulin excess can lead to weight gain and potentially contribute to hypertension indirectly, but the primary symptoms described point more directly to glucocorticoid excess.
Do Not Miss Diagnoses
- H) Mineralocorticoid excess: This condition, such as primary aldosteronism, can cause significant hypertension and hypokalemia. Although less likely given the constellation of symptoms, it's crucial to consider due to its potential for severe hypertension and the importance of early diagnosis.
- C) Glucocorticoid deficiency: While less likely given the symptoms of excess (such as weight gain and hypertension), adrenal insufficiency can sometimes present with hypotension and would be critical to diagnose due to its potential for life-threatening adrenal crisis.
Rare Diagnoses
- A) Catecholamine deficiency: This is not typically associated with hypertension and would be an unusual diagnosis in this context.
- G) Mineralocorticoid deficiency: Conditions like Addison's disease can lead to hypotension rather than hypertension, making this an unlikely cause of the patient's symptoms.
- OG) Insulin excess as a primary cause of the symptoms described is less likely compared to glucocorticoid excess, given the broader range of symptoms presented.