Malignant Hypertension and Osteoporotic Fractures in a 15-year-old Boy.

Abstract

1. Salaheddin H. Elrokhsi, MD* 2. Rachel Baumann Manzo, MD† 3. Mark D. Wheeler, MD† 4. Rajan Senguttuvan, MD‡ 5. Cindy N. Chin, MD† 1. *University of Nebraska Medical Center, Omaha, NE 2. †University of Arizona, Tucson, AZ 3. ‡Driscoll Children’s Hospital, Corpus Christi, TX A 15-year-old boy with years of poor linear growth presents to the emergency department (ED) with 1 day of headache, blurry vision, and intermittent palpitations associated with elevated blood pressure (BP) (home BP using his mother’s BP monitor is 181/133 mm Hg). On presentation he denies chest or abdominal pain, nausea, syncope, diplopia, dysuria, numbness, and weakness. BP at his pediatrician’s office on the day before ED presentation was 190/110 mm Hg. Several weeks earlier the patient had reestablished care with his pediatrician after a lapse of 4 years. He was seen for back pain after 2 falls from his skateboard with documented BP of 102/60 mm Hg. At that visit his weight was 98.3 lb (44.6 kg) (3.6 percentile for age), height was 57.6 in (146.3 cm) (0.1 percentile for age), and BMI was 20.8 (58th percentile for age). At age 11.5 years his weight had been 100 lb (45.4 kg) (77th percentile for age) and height had been 57 in (144.8 cm) (39th percentile for age). On examination in the ED the patient’s vital signs are notable for a pulse of 142 beats/min and BP of 193/149 mm Hg, assessed in the left upper extremity. Repeated BPs in the right upper and lower extremities are similarly elevated. The patient has flushed cheeks, bruising of the bilateral lower extremities, and Tanner II genital development. His neurologic examination findings are normal. Aside from tachycardia and hypertension, his cardiovascular examination findings are normal. His abdomen is soft, nontender, and nondistended, without palpable masses. He has truncal obesity but no abdominal striae. Initial laboratory evaluation is significant for an …