Q. I am 28 and I have been diagnosed with hypertension and polycystic ovary syndrome (PCOS) recently by a polyclinic doctor. The rest of my blood and urine tests (including tests for thyroid function and diabetes) results were normal. The doctor told me to continue with my medication, monitor my blood pressure and not to worry about it. On my second visit to the polyclinic, another doctor referred me to a endocrinologist for further tests because of my young age. Both my parents suffer from hypertension too.

After the first consultation with the specialist, I was told that my hypertension might be due to my obese condition (my BMI is about 31.5). However, he has requested me to do some more tests (including a chest x-ray, 24-hour urine test and blood pressure monitoring).

I have been undergoing a lot of tests and this has increased my stress level tremendously. Is it really necessary to undergo all these tests again? Should I get a second opinion with a more senior specialist?

A. Hypertension or high blood pressure is categorised under two forms: essential (or primary) hypertension and secondary hypertension. Essential hypertension is the more common form, accounting for more than 90 percent of hypertension. Many factors such as genes and environmental influences like diet and lifestyle contribute to its development.

In secondary hypertension, an underlying cause can be found. It is due to a specific abnormality in one of the organs or systems of the body, possibly the kidneys, blood vessels or hormone glands. Secondary hypertension should be considered in all individuals with hypertension at a young age (as in your case) or when blood pressure is difficult to control despite taking medication regularly. It is also considered when your doctor detects that you have other symptoms or signs that occur with these secondary causes. It is important to work up and exclude secondary hypertension: these conditions tend to cause more severe hypertension and may result in more complications, either from the higher blood pressure itself, or from the other effects of the underlying condition. Some of these conditions have specific treatments and the hypertension may sometimes be curable.

It is unclear in your letter how the diagnosis of PCOS was made at the polyclinic. PCOS is characterised by irregular or absent menses, signs of male hormone excess (such as acne, male pattern baldness) and numerous fluid-filled cysts found in both ovaries on ultrasound (the result of disruption in the reproductive cycle and failed ovulation). Several other hormonal disorders can cause symptoms and signs similar to those of PCOS and have to be excluded before the diagnosis is made.

Women with PCOS often have difficulty conceiving, are overweight and are at increased risk of diabetes, cardiovascular disease and cancer of the lining of the womb. The initial work-up for the cause of your hypertension involves an extensive series of tests. The good news is that once diagnosed, these conditions can be monitored through clinical examination and blood tests. With early diagnosis and treatment, control can be achieved and complications prevented.

DR LOH LIH MING, CONSULTANT, PUTUITARY & ADRENAL SERVICE, DEPARTMENT OF ENDOCRINOLOGY, SGH