What is a likely pathological mechanism causing hypertension in a young female with a mid-systolic murmur and lateralized abdominal bruit?

The presence of a mid-systolic murmur along with a lateralized abdominal bruit in a young female suggests the possibility of vascular abnormalities, particularly those affecting the renal arteries. Fibromuscular dysplasia is a condition characterized by abnormal development or growth of the cells in the walls of blood vessels, which most commonly affects the renal arteries in young females. This condition can lead to renal artery stenosis, which impairs blood flow to the kidneys, prompting the activation of the renin-angiotensin-aldosterone system (RAAS) and resulting in secondary hypertension.

In this case, the murmur could be indicative of turbulent blood flow through a narrowed artery, while the abdominal bruit reflects the abnormal sound of blood flow in the affected renal artery. The combination of these clinical findings aligns well with fibromuscular dysplasia, making it the most likely pathological mechanism for the patient’s hypertension.

Other conditions listed may cause hypertension, but they do not fit the specific presentation as well. For instance, oversecretion of aldosterone could cause hypertension but would not typically present with the specific signs of the murmur and bruit. Primary hyperparathyroidism usually leads to hypercalcemia but is not directly associated with the described cardiovascular findings. Chronic kidney disease