Family history of renal disease. Difficult to control hypertension. Many acute and chronic renal disorders are associated with hypertension. A urinalysis with careful examination of the sediment, BUN, and creatinine will reasonably screen for most of these. Suggestive features include an abdominal bruit, especially if there is a diastolic component, appropriate age, and a rapidly accelerating course.
Primary aldosteronism is caused by an adrenal adenoma or primary adrenal hyperplasia.
Cushing's Syndrome is suggested by typical physical findings of central obesity, moon facies, and purple striae. Pheochromocytoma 0.2Percent Pheochromocytoma is manifested by marked swings in blood pressure, a significant orthostatic drop in blood pressure, and spells of sweating, tachycardia, and tremulousness. This is usually asymptomatic. Physical findings include a wide pulse pressure in the upper extremities, a lower than expected blood pressure in the lower extremities, a delay in the femoral pulse compared to the brachial pulse, and a systolic murmur between the scapulae. The chest X-ray may show post stenotic dilatation of the aorta and notching of the inferior edge of the ribs.