Sustained severe hypertension in children is most commonly suggestive of –
**Core Concept**
The question is testing the ability to identify a rare but serious cause of sustained severe hypertension in children. This condition is often associated with a specific genetic disorder that affects the kidneys.
**Why the Correct Answer is Right**
The correct answer is a genetic disorder that leads to an overproduction of renin, a hormone that regulates blood pressure. This overproduction causes the kidneys to retain sodium and water, leading to increased blood pressure. The condition is characterized by the presence of renin-secreting tumors in the kidneys, which are often bilateral. The renin-secreting tumors are usually benign but can cause significant hypertension if left untreated.
**Why Each Wrong Option is Incorrect**
* **Option A:** Although coarctation of the aorta is a common cause of hypertension in children, it is not the most common cause of sustained severe hypertension. Coarctation of the aorta typically presents with hypertension in the arms and decreased or delayed pulses in the lower extremities.
* **Option B:** Renal artery stenosis is a cause of hypertension in children, but it is not as common as the correct answer. Renal artery stenosis is often associated with fibromuscular dysplasia, which is a non-atherosclerotic, non-inflammatory vascular disease.
* **Option C:** Cushing's syndrome is a rare cause of hypertension in children. It is caused by excess cortisol production, which can lead to hypertension, but it is not the most common cause of sustained severe hypertension in children.
**Clinical Pearl / High-Yield Fact**
Remember that in children, sustained severe hypertension is often a sign of an underlying genetic disorder, such as the correct answer. Always consider this possibility when evaluating a child with hypertension.
**Correct Answer:** C.