A rare cause of severe hypertension with hypokalemic metabolic alkalosis in a 14-year-old girl: Questions

Excerpt

A 14-year-old girl presented with excessive weight gain and progressive swelling of both lower limbs for 1 month. There was also a history of polyuria (urine output 4.5 L/day) accompanied by anorexia and tiredness for the last 10 days. She initially sought consultation for these complaints at another hospital, where a general practitioner noted high blood pressure readings (160/110 mmHg, stage 2 hypertension). In view of hypertension and polyuria, she was referred to the pediatric nephrology clinic at our hospital. There was no history of vomiting, headache, recurrent respiratory infections, palpitations, orthopnea, paroxysmal nocturnal dyspnea, tetany, cola-colored urine, or diarrhea. She denied intake of drugs, traditional medicines, or steroids. The Tanner sexual maturity rating was appropriate for age and she had attained menarche at 12 years of age. However, the menstrual periods had been irregular for the last 2 months. On examination, her face had a rounded appearance, with extensive acneiform eruptions. She also had abdominal distension, and bilateral pitting pedal edema, but no periorbital edema. There were no neurocutaneous markers. All peripheral pulses were normally felt. The vital signs at presentation were respiratory rate 18/min, heart rate 78/min, and blood pressure 150/110 mmHg (stage 2 hypertension). She was not found to have any significant difference between readings of blood pressure measured in all the four limbs. She was hemodynamically stable at admission, and there were no signs of dehydration. Her weight and height were 50 kg (0.06 Z) and 151 cm (− 1.56 Z) respectively. Her mother revealed that her weight was 43 kg 1 month ago. There was no palpable abdominal mass, hepatosplenomegaly, or ascites. There was no abdominal bruit. Cardiovascular and neurological examinations were normal. …