Mayo Clinic College of Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Eye (Lond). 2010 Dec;24(12):1792-6. doi: 10.1038/eye.2010.125. Epub 2010 Sep 24.
although elevated urinary catecholamine levels have been reported in 90-95% of patients with neuroblastoma, more recent studies of pediatric Horner syndrome caused by an underling neuroblastoma have reported normal values at presentation. The purpose of this population-based study is to report the percentage of cases of neuroblastoma with elevated urinary catecholamine levels at presentation and to suggest a recommended work-up for cases of idiopathic pediatric Horner syndrome.
the medical records of all pediatric (<19 years) residents of Olmsted County, Minnesota diagnosed with neuroblastoma from 1 January 1969 through 31 December 2008 were retrospectively reviewed.
a total of 14 patients <19 years of age were diagnosed with neuroblastoma as residents of Olmsted County, Minnesota, during the 40-year study period. A total of 10 (71%) of the 14 cases manifested elevated urinary catecholamine metabolites at the initial presentation. Urinary vanillylmandelic acid (VMA) levels were greater than twice the upper limit of normal in eight (57%) of 14 cases, whereas homovanillic acid (HVA) levels were greater than two times the upper limit of normal in 10 (71%) of the 14 cases. Three (75%) of the four cases without significantly elevated urinary VMA or HVA levels were diagnosed with stage IV disease, whereas one (25%) had stage II neuroblastoma.
urinary catecholamine levels were significantly elevated at presentation in 10 (71%) of the 14 neuroblastoma cases during the 40-year study period, suggesting that greater emphasis be placed on performing a thorough physical examination and obtaining warranted imaging studies in cases of idiopathic pediatric Horner syndrome.
虽然已有研究报道 90-95%的神经母细胞瘤患者存在尿儿茶酚胺水平升高，但最近有研究报道，部分由神经母细胞瘤引起的儿童霍纳综合征患者的尿儿茶酚胺水平在初诊时正常。本基于人群的研究旨在报告初诊时尿儿茶酚胺水平升高的神经母细胞瘤病例比例，并提出疑似特发性儿童霍纳综合征患者的推荐检查方案。
回顾性分析明尼苏达州奥姆斯特德县 1969 年 1 月 1 日至 2008 年 12 月 31 日期间诊断为神经母细胞瘤的所有<19 岁的儿科（<19 岁）居民的病历。
在 40 年的研究期间，明尼苏达州奥姆斯特德县共有 14 名<19 岁的儿童被诊断为神经母细胞瘤。在初始表现中，有 14 例中的 10 例（71%）存在尿儿茶酚胺代谢物升高。在 14 例中，有 8 例（57%）的香草扁桃酸（VMA）水平超过正常上限的两倍，而 10 例（71%）的高香草酸（HVA）水平超过正常上限的两倍。在无明显升高的尿 VMA 或 HVA 水平的 4 例中，有 3 例（75%）被诊断为 IV 期疾病，1 例（25%）为 II 期神经母细胞瘤。
在 40 年的研究期间，14 例神经母细胞瘤病例中有 10 例（71%）在初诊时尿儿茶酚胺水平显著升高，这表明在疑似特发性儿童霍纳综合征患者中，应更加重视进行全面的体格检查，并进行必要的影像学检查。
