Pheochromocytoma may produce headaches, flushing, and dramatic blood pressure lability. Occlusive renal artery disease may produce headaches and renal artery bruits. Occlusive renal artery disease is more likely when a renal artery bruit has a diastolic component than when it has only a systolic component. Patients with primary aldosteronism have muscle weakness, nocturia, isosthenuria, altered carbohydrate metabolism, and hypokalemic alkalosis. Cushing's syndrome is suggested by hypokalemic alkalosis, the typical facies, hirsutism, purplish abdominal striae, buffalo hump, and new appearance of acneiform lesions.
Proteinuria occurs late in the course of uncomplicated essential hypertension.
An alkaline pH in a fresh urine sample suggests hypokalemia or primary aldosteronism. The chest x-ray is less specific than the ECG for detecting cardiac enlargement. An enlarged left atrium does not indicate atrial disease per se but is probably secondary to reduced left ventricular compliance resulting from left ventricular hypertrophy. An echocardiogram can show ventricular hypertrophy. Moreover, the echocardiogram can distinguish primarily systolic dysfunction from primarily diastolic dysfunction.