HYPERTESION....

A 36 years old woman presents to the urgent care clinic for furthur evaluation of hypertension. she has had yearly physicals and has never been noted to have hypertension in the past. she has been taking her blood pressure at a local grocery store and over the past several months has noted a gradual rise, with recent values as high as 180/100. she has no history of DM, smoking, high cholestrol, or family history of hypertension and denies chest pain, dyspnea, claudication, or neurologic symptoms. she is taking no medications. today, her BP is 170/90 in both arms. she is in no distress and is not obese. cardiac examination is unremarkable; radial and femoral pulses are equal.

what is the most likely diagnosis?

a- cushing syndrom.
b- essential hypertension.
c- coarctation of aorta.
d- fibromuscular dysplasia of renal arteries.
e- pheochromocytoma.

may be essential hypertention
the patient has no symtoms of cushing syndrome she is not obese and she is not taking any medication(steroids) so it is not cushing syndrome ..
the BP on both arms is equal so it is not coarctation of the aorta...
pheochromocytoma is unlikely bcoz the patient "is not in distress" not sweaty not fatigue no cardiac manifestation such as palpitation...
and i dont know wat is renal arteries dysplasia but no signs of renal failure
but she is young for essential hypertention isnt she??

I agree with Dr. basma since no cause can be seen it's essential HT which is account for 95 % of all hypertension

Happy New Year 2008.... Hoping that the next year will fill with Peace, Happiness & Love.
Dear ahmed...i do not agree with them about the Dx.....To me:
No radiofemoral dalay .... it is not a corractation of aorta.
NOT (obese, taking drugs, no other visible shape abnormalities).....NOT a cushing syndrome.
NO (episodic headache, Nausea, vomiting, flactuation in BP).....NOT phaeochromocytoma........SO:
fibromuscular dysplsia of renal artery must be kept in mind as a strong cause of this case because:
1- It is a congenital disorder involving thickening of the arterial wall and is a cause of renal artery stenosis in younger adults, particularly women 20 - 40 years old.
2- It can be asymptomatic...but can cause a symptomes like claudications & other symptoms due to vascular insufficiency (all of which is denied by the patient).
till now it is fibromuscular dysplasia....SO I will do :
1- Abdominal examination for her (Looking for renal artery bruit).
2- U/S: looking for asymetry of the kidney....if still in suspicion..
3- Renal arteriography....for definite diagnosis of the stenosis.
all of this if negative ..... then the patient has essentioal hypertension.

hmm...happy new year first and thanks dr mohammed for the explanation ..the term "fibromuscular dysplsia of renal artery " is kind of new to me..and i really apreciate the brief notes u mentioned about the disease.. I WILL KEEP THIS DISAESE IN MY MIND ! (A first new disease i learn in 2008 ) thanks again

hi all, happy new year wishing u all the best in ur life, thaks for ur participation in this website...

the answer as dr. mahammed said is fibromuscular dysplasia of real artery...

In young women with no other medical problems and no family history of high BP but with new onset of accelerated hypertension, there is likely a secondary cause..

fibromuscular dysplasia is a rare type of hyperplasia affecting medium sized and large arteries in younger patients, more often women...the resulting stenosed renal artey leads to relative hypoperfusion of the kidneys and a compensatory hypertensive respose as the body attempt to increase perfusion....

A normal body habit makes cushing syndrom unlikely, as it is usually associated with signs of steroid excess....

Equal upper and lower pulses essentially rule out coarctation of aorta.

Phaeochromocytoma usually presents with paroxysmal flushig and palpitations as wellas labile blood pressure.

Although essential hypertension can first develop in the third decade of life, it is generally gradual in onset and the majority of patients (60-80%) have a family history of hypertension....