Make the Dx: Solution to 'Headaches and hypertension'

By MDLinx staff
Published October 11, 2023
ADMIN2-erenumabmigraine1.jpg headache

Key Takeaways

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Several conditions could be included on the list of differential diagnoses in this patient, including:

  • Cushing syndrome

  • Primary aldosteronism (Conn syndrome)

  • Multiple endocrine neoplasia type 2A (MEN 2A, or Sipple syndrome)

  • Adrenal insufficiency (Addison disease)

  • 22q11.2 deletion syndrome (DiGeorge syndrome).

Although patients with Cushing syndrome can be hypertensive, the hypertension is not refractory to treatment and reflects excess mineralocorticoid activity.

Patients with adrenal insufficiency have postural hypotension and hyponatremia.

Multiple endocrine neoplasia type 2A (MEN 2A, or Sipple syndrome) typically involves severe headaches, but it does not usually involve electrolyte abnormalities. In addition, other key symptoms of the disease, such as tachycardia, angina, and palpitations, are not present in this patient. 22q11.2 deletion syndrome, another of the differentials on the list, typically does not result in hypertension or headaches.

This patient most likely has primary aldosteronism. Excess aldosterone is associated with resistant elevated blood pressure and low potassium levels.

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