Secondary Hypertension & Neurofibromatosis
CC: high blood pressure, in young < 30 years of age
Differential diagnosis of secondary hypertension:
Cushing syndrome
Renal artery stenosis
Conn’s
Pheochromocytoma
Neurofibromatosis
OBSTRUCTIVE SLEEP APNEA
Acromegaly
Pregnant , think of pre-eclampsia
Aortic coarctation
Hypo-hyperthyroidism
What will you do ?
ECG, Echo
Renal doppler
24h urine cortisol
Blood renin/aldosterone ratio
Urine metanephrine & normetanephrine
Basic profile like CBC, RFT, TSH, LIPID, …
Polysomnography
NEUROFIBROMATOSIS
AUTOSOMAL DOMINANT
CLINICAL SIGNS:
neurofibromas (small bumps in or under the skin): TWO OR MORE
CAFÉ AU LAIT PATCHES: SIX OR MORE, > 15 mm DIAMETER IN
ADULTS
AXILLARY FRECKLING
LISCH NODULES: MELANOCYTIC HAMARTOMAS OF THE IRIS
Area to examine:
Skin
Abdomen
CHEST FOR CRACKLES ( HONEYCOMB LUNG & FIBROSIS )
VISUAL ACUITY: OPTIC GLIOMA or COMPRESSION
NEUROPATHY & LARGE PALPAPLE NERVE
