Table 1.

Common Causes of Secondary Hypertension in Young Women

	Physical Exam	Diagnostic Tools	Confirmatory Findings
Structural
Fibromuscular Dysplasia	-Epigastric bruit -Cervical bruit -May be associated with aneurysms, dissections (carotid, vertebral, coronary)	-CTA or MRA -Renal artery duplex ultrasound -Catheter based angiography	Multifocal FMD: String of beads in the mid to distal portion of the artery Focal FMD: a concentric or tubular stenosis
Coarctation of the Aorta	-Brachial-Femoral Delay -Diminished lower extremity pulses and BP -Continuous “machine-like” murmur over posterior chest	-Echocardiography -CTA or MRA	-Increased descending thoracic aorta velocity and persistent diastolic runoff on echo -Persistent diastolic runoff of abdominal aorta on echo -Focal narrowing just distal to left subclavian artery origin on angiography
Turner Syndrome	-Short stature -Webbed neck- -Primary or secondary amenorrhea -Incomplete breast development	-Karyotype analysis	-45, X -45, X mosaicism -46 X, Partial X deletion -45, X/46, XY
Endocrine
Primary Hyperaldosteronism	-Hypokalemia -Hypernatremia	-Plasma aldosterone and renin levels -Adrenal CT imaging	-Elevated plasma aldosterone level (typically >15 ng/dL) -Elevated aldosterone: renin ratio (typically >20) -Adrenal adenoma or hyperplasia on imaging

CTA=coronary tomographic angiography, MRA=magnetic resonance angiography