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Difficulty: EasyGeneral Internal Medicine

Match each clinical presentation to its most likely cause of secondary hypertension.

  • Episodic palpitations, diaphoresis, and severe headachePheochromocytoma
  • Resistant hypertension associated with spontaneous hypokalemiaPrimary hyperaldosteronism
  • Severe, new-onset hypertension with an abdominal bruitRenal artery stenosis
  • Resistant hypertension, obesity, loud snoring, and daytime somnolenceObstructive sleep apnea

Answer

The correct matches pair episodic sympathetic symptoms with pheochromocytoma, hypokalemia with primary hyperaldosteronism, abdominal bruits with renal artery stenosis, and snoring with obstructive sleep apnea.
Secondary causes of hypertension present with distinct clinical clues that help differentiate them from primary (essential) hypertension. Pheochromocytoma is characterized by paroxysmal sympathetic hyperactivity. Primary hyperaldosteronism leads to aldosterone-mediated hypokalemia. Renal artery stenosis typically presents with signs of renovascular disease, notably an abdominal bruit. Obstructive sleep apnea is strongly associated with mechanical airway obstruction signs, such as snoring and excessive daytime somnolence.

Step-by-Step Solution

1
Analyze the first presentation ('Episodic palpitations, diaphoresis, and severe headache').
This classic triad suggests episodic surges in catecholamines.
Pheochromocytoma is a catecholamine-secreting adrenal tumor.
2
Analyze the second presentation ('Resistant hypertension associated with spontaneous hypokalemia').
Hypokalemia in the setting of hypertension suggests an excess of mineralocorticoids.
Primary hyperaldosteronism leads to increased sodium reabsorption and potassium excretion.
3
Analyze the third presentation ('Severe, new-onset hypertension with an abdominal bruit').
An abdominal bruit indicates turbulent blood flow in the renal arteries.
Renal artery stenosis restricts renal blood flow, persistently activating the renin-angiotensin-aldosterone system.
4
Analyze the fourth presentation ('Resistant hypertension, obesity, loud snoring, and daytime somnolence').
These are the hallmark signs of sleep-disordered breathing.
Obstructive sleep apnea causes intermittent hypoxemia and increased sympathetic tone, leading to elevated blood pressure.

Key Concept

Clinical presentations of secondary hypertension
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Topics

General Internal Medicine

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