TABLE 14

Examples of Physical Examination Findings and History Suggestive of Secondary HTN or Related to End Organ Damage Secondary to HTN

Body SystemFinding, HistoryPossible Etiology
Vital signsTachycardiaHyperthyroidism
PCC
Neuroblastoma
Decreased lower extremity pulses; drop in BP from upper to lower extremitiesCoarctation of the aorta
EyesProptosisHyperthyroidism
Retinal changesaSevere HTN, more likely to be associated with secondary HTN
Ear, nose, throatAdenotonsillar hypertrophySDB
History of snoringSleep apnea
Height, weightGrowth retardationChronic renal failure
Obesity (high BMI)Cushing syndrome
Truncal obesityInsulin resistance syndrome
Head, neckElfin faciesWilliams syndrome
Moon faciesCushing syndrome
Thyromegaly, goiterHyperthyroidism
Webbed neckTurner syndrome
SkinPallor, flushing, diaphoresisPCC
Acne, hirsutism, striaeCushing syndrome
Anabolic steroid abuse
Café-au-lait spotsNeurofibromatosis
Adenoma sebaceumTuberous sclerosis
Malar rashSystemic lupus
Acanthosis nigricansT2DM
HematologicPallorRenal disease
Sickle cell anemia
Chest, cardiacChest painHeart disease
Palpitations
Exertional dyspnea
Widely spaced nipplesTurner syndrome
Heart murmurCoarctation of the aorta
Friction rubSystemic lupus (pericarditis)
Collagen vascular disease
Apical heaveaLVH
AbdomenAbdominal massWilms tumor
Neuroblastoma
PCC
Epigastric, flank bruitRAS
Palpable kidneysPolycystic kidney disease
Hydronephrosis
Multicystic dysplastic kidney
GenitourinaryAmbiguous or virilized genitaliaCongenital adrenal hyperplasia
Urinary tract infectionRenal disease
Vesicoureteral reflux
Hematuria, edema, fatigue
Abdominal trauma
ExtremitiesJoint swellingSystemic lupus
Collagen vascular disease
Muscle weaknessHyperaldosteronism
Liddle syndrome
Neurologic, metabolicHypokalemia, headache, dizziness, polyuria, nocturiaReninoma
Muscle weakness, hypokalemiaMonogenic HTN (Liddle syndrome, GRA, AME)
  • AME, apparent mineralocorticoid excess; GRA, glucocorticoid-remediable aldosteronism. Adapted from Flynn JT. Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol. 2001;12(2):177–188; National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2):555–576.

  • a Findings that may be indicative of end organ damage related to HTN.