In evaluating pediatric hypertension, which test is NOT typically used to assess secondary causes?

• A. Serum renin and aldosterone
• B. Lipid panel
• C. Renal ultrasound with Doppler
• D. Plasma metanephrines

Answer: (D)

The key idea is that when evaluating hypertension in children for secondary causes, you use tests that target common, reversible issues, and you reserve more specific tests for when a particular condition is suspected. Measuring plasma renin and aldosterone helps detect abnormalities in the renin–angiotensin–aldosterone system, which can point to renovascular hypertension or mineralocorticoid excess. A renal ultrasound with Doppler directly looks for structural problems or reduced blood flow in the kidneys, another common avenue for secondary hypertension in kids. In contrast, plasma metanephrines are used to screen for pheochromocytoma, a rare but possible cause of secondary hypertension. Because pheochromocytoma is uncommon in the pediatric population, this test is not part of routine initial screening for secondary causes unless there are specific symptoms or signs suggestive of pheochromocytoma. Therefore, it isn’t typically used in the standard secondary-workup, which is why it’s the best choice for this question.