Causes of Secondary Hypertension - Differential Diagnosis ...
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Causes of Secondary Hypertension - Differential Diagnosis and Screening Testing

Common causes: 

 • Renal parenchymal disease - Renal ultrasound,  Tests to evaluate cause of renal disease

 • Renovascular disease - Renal Duplex Doppler ultrasound; MRA; abdominal CT, Bilateral selective renal intra-arterial angiography

 • Primary aldosteronism - Plasma aldosterone/renin ratio under standardized conditions (correction of hypokalemia and withdrawal of aldosterone antagonists for 4–6 wk). Oral sodium loading test (with 24-h urine aldosterone) or IV saline infusion test with plasma aldosterone at 4 h of infusion Adrenal CT scan, adrenal vein sampling.

 • Obstructive sleep apnea - Berlin Questionnaire; Epworth Sleepiness Score; overnight oximetry. Polysomnography

 • Drug or alcohol induced - Urinary drug screen (illicit drugs) Response to withdrawal of suspected agent

Uncommon causes: 

 • Pheochromocytoma/para ganglioma - 24-h urinary fractionated metanephrines or plasma metanephrines under standard conditions (supine position with indwelling IV cannula). CT or MRI scan of abdomen/pelvis

 • Cushing’s syndrome - Overnight 1-mg dexamethasone suppression test. 24-h urinary free cortisol excretion (preferably multiple); midnight salivary cortisol

 • Hypothyroidism

 • Hyperthyroidism

 • Aortic coarctation (undiagnosed or repaired)

 • Primary hyperparathyroidism

 • Congenital adrenal hyperplasia

 • Mineralocorticoid excess syndromes other than primary aldosteronism

 • Acromegaly



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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