Match each classic clinical presentation of secondary hypertension to its most likely underlying etiology.
- Resistant hypertension accompanied by spontaneous hypokalemia and metabolic alkalosisPrimary hyperaldosteronism
- Paroxysmal severe hypertension episodes associated with sudden-onset pounding headaches, diaphoresis, and tachycardiaPheochromocytoma
- Recent-onset severe hypertension in a young adult female, accompanied by a high-pitched systolic-diastolic abdominal bruitFibromuscular dysplasia
- Progressive hypertension associated with recurrent flank pain, microscopic hematuria, and bilaterally palpable abdominal massesAutosomal dominant polycystic kidney disease
Answer
Hypokalemia/alkalosis matches with Primary hyperaldosteronism; Episodic headache/diaphoresis matches with Pheochromocytoma; Abdominal bruit in young female matches with Fibromuscular dysplasia; Palpable flank masses/hematuria matches with Autosomal dominant polycystic kidney disease.
Secondary hypertension should be suspected when hypertension is resistant, early-onset, or associated with specific syndromic features. Identifying the specific etiology relies on pattern recognition: hypokalemia/alkalosis points to aldosterone excess; episodic sympathetic triads point to catecholamines; bruits in young females point to vascular dysplasia; and palpable kidneys with hematuria point to polycystic disease.
Step-by-Step Solution
Key Concept
Recognition of distinct clinical and laboratory patterns is essential for identifying the specific etiologies of secondary hypertension.