Torres A D, Rai A N, Hardiek M L
Department of Pediatric Nephrology, Michigan State University Kalamazoo Center for Medical Studies, Kalamazoo, Michigan 49008, USA.
Pediatrics. 2000 Mar;105(3):E34. doi: 10.1542/peds.105.3.e34.
Two children in the same household with symptomatic arterial hypertension simulating pheochromocytoma were found to be intoxicated with elemental mercury. The first child was a 4-year-old boy who presented with new-onset seizures, rash, and painful extremities, who was found to have a blood pressure of 171/123 mm Hg. An extensive investigation ensued. Elevated catecholamines were demonstrated in plasma and urine; studies did not confirm pheochromocytoma. Mercury levels were elevated. These findings prompted an evaluation of the family. A foster sister had similar findings of rash and hypertension. Both had been exposed to elemental mercury in the home. The family was temporarily relocated and chelation therapy was started. A Medline search for mercury intoxication with hypertension found 6 reports of patients ranging from 11 months to 17 years old. All patients showed symptoms of acrodynia. Because of the clinical presentation and the finding of elevated catecholamines, most of the patients were first studied for possible pheochromocytoma. Subsequently, elevated levels of mercury were found. Three children had contact with elemental mercury from a broken thermometer, 2 had played with metallic mercury and 1 had poorly protected occupational exposure. All responded to chelation therapy. Severe systemic arterial hypertension in infants and children is usually secondary to an underlying disease process. The most frequent causes of hypertension in this group include renal parenchymal disease, obstructive uropathy, and chronic pyelonephritis associated with reflux and renal artery stenosis. Less frequent causes include adrenal tumors, pheochromocytomas, neurofibromas, and a number of familial forms of hypertension. Other causes include therapeutic and recreational drugs, notably sympathomimetics and cocaine, and rarely, heavy metals. In children with severe hypertension and elevated catecholamines, the physician should consider mercury intoxication as well as pheochromocytoma. The health hazards of heavy metals need to be reinforced to the medical profession and the general public.
同一家庭中两名出现类似嗜铬细胞瘤症状性动脉高血压的儿童被发现汞中毒。第一名儿童是一名4岁男孩，出现新发癫痫、皮疹和四肢疼痛，血压为171/123 mmHg。随后展开了全面调查。血浆和尿液中儿茶酚胺水平升高；检查未证实患有嗜铬细胞瘤。汞水平升高。这些发现促使对该家庭进行评估。一名寄养姐妹有类似的皮疹和高血压症状。两人都在家中接触过元素汞。该家庭被临时搬迁，并开始进行螯合疗法。对汞中毒伴高血压进行的医学文献检索发现了6例报告，患者年龄从11个月至17岁不等。所有患者均表现出肢痛症状。由于临床表现以及儿茶酚胺水平升高的发现，大多数患者首先接受了是否可能患有嗜铬细胞瘤的检查。随后，发现汞水平升高。3名儿童因温度计破损接触了元素汞，2名儿童玩过金属汞，1名儿童职业接触防护不当。所有患者对螯合疗法均有反应。婴幼儿和儿童的重度系统性动脉高血压通常继发于潜在的疾病过程。该群体中高血压最常见的病因包括肾实质疾病、梗阻性尿路病以及与反流和肾动脉狭窄相关的慢性肾盂肾炎。较不常见的病因包括肾上腺肿瘤、嗜铬细胞瘤、神经纤维瘤以及多种家族性高血压形式。其他病因包括治疗性和娱乐性药物，尤其是拟交感神经药和可卡因，以及罕见的重金属。对于患有重度高血压且儿茶酚胺水平升高的儿童，医生应考虑汞中毒以及嗜铬细胞瘤。重金属对健康的危害需要向医学界和公众加强宣传。
