Severe Hypertension in a 14-Year-Old Boy

Inas H. Thomas, MD

Disclosures

May 31, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 14-year-old boy with no significant medical history presents with a worsening headache over the past 2 days. His parents report that he started complaining of a headache the day before, when he came home from school. His parents gave him ibuprofen, which seemed to help him sleep. However, today he has the headache again and has been sweaty and flushed. His parents thought he may be developing migraines because he also complained of blurred vision, nausea, and dizziness. The patient's father has a history of migraines. The patient has had similar headaches over the past few months.

The patient has been struggling at school, with both a decline in behavior and schoolwork over the past few months. His parents are worried that stress may be triggering the headache or migraine, owing to multiple stressors; these include the boy's recent evaluation for attention-deficit/hyperactivity disorder. He has also had abdominal pain with some looser stools. His parents do not report fever or significant weight gain or loss.

The patient has no past medical or surgical history. Medications include ibuprofen as needed. His family history includes his father's migraines; his mother has Hashimoto thyroiditis and is being evaluated for kidney cancer. His maternal grandfather died of a stroke in his early 30s. With his parents outside the room, the boy denies illicit drug use.

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