An infant with failure to thrive, hypertension, metabolic alkalosis and hyperkalemia presents to a clinician. Most probable cause is
**Core Concept**
The underlying condition presented involves a complex interplay of electrolyte imbalance, blood pressure regulation, and metabolic disturbances, hinting at a renal or adrenal issue. **Hyperaldosteronism** or **hypoaldosteronism** could be key, given the symptoms of hypertension, metabolic alkalosis, and hyperkalemia.
**Why the Correct Answer is Right**
Given the symptoms of hypertension, metabolic alkalosis, and hyperkalemia, the most probable cause is a condition that leads to an excess of aldosterone effect, such as **Conn's syndrome** (primary aldosteronism), but the presence of hyperkalemia instead of hypokalemia suggests a different pathology. A condition that could explain these findings is **Gordon's syndrome** (familial hyperkalemic hypertension), characterized by hyperkalemia, hypertension, and metabolic acidosis is not typically seen, but the closest match given the options is likely related to an abnormality in the **aldosterone** pathway or its effect, yet the specifics of the question point towards a condition affecting **renin-angiotensin-aldosterone system** but with an opposite effect on potassium levels.
**Why Each Wrong Option is Incorrect**
**Option A:** Would typically present with hypokalemia, not hyperkalemia.
**Option B:** Not directly related to the specific combination of symptoms presented.
**Option C:** Could be a consideration but does not typically present with the combination of hyperkalemia and metabolic alkalosis as primary features.
**Clinical Pearl / High-Yield Fact**
It's crucial to remember that the combination of hypertension, metabolic alkalosis, and hyperkalemia is unusual and suggests a specific group of disorders affecting the renin-angiotensin-aldosterone system, particularly those that mimic aldosterone excess but with an abnormal potassium handling.
**Correct Answer: D.**