Ambarsari Cahyani Gita, Hidayati Eka Laksmi, Tridjaja Bambang, Mochtar Chaidir Arif, Wulandari Haryanti Fauzia, Harahap Agnes Stephanie, Grace Angela
Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Glob Pediatr Health. 2021 May 12;8:2333794X211015484. doi: 10.1177/2333794X211015484. eCollection 2021.
Secondary hypertension in children, to the rare extent, can be caused by endocrine factors such as pheochromocytoma, an adrenal tumor that secretes catecholamine. Only a few cases have been reported in the past 3 decades. To the best of our knowledge, this is the first case report of pediatric pheochromocytoma from Indonesia. We reviewed a case of a 16-year-old Indonesian boy with history of silent hypertensive crisis who was referred from a remote area in an island to the pediatric nephrology clinic at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Despite medications, his symptoms persisted for 14 months. At the pediatric nephrology clinic, pheochromocytoma was suspected due to symptoms of catecholamine secretion presented, which was palpitation, diaphoresis, and weight loss. However, as the urine catecholamine test was unavailable in Indonesia, the urine sample was sent to a laboratory outside the country. The elevated level of urine metanephrine, focal pathological uptake in the right adrenal mass seen on I-MIBG, and histopathology examination confirmed the suspicion of pheochromocytoma. Following the tumor resection, he has been living with normal blood pressure without antihypertensive medications. This case highlights that pheochromocytoma should always be included in the differential diagnoses of any atypical presentation of hypertension. In limited resources setting, high clinical awareness of pheochromocytoma is required to facilitate prompt referral. Suspicion of pheochromocytoma should be followed by measurement of urine metanephrine levels. Early diagnosis of pheochromocytoma would fasten the optimal cure, alleviate the symptoms of catecholamine release, and reverse hypertension.
儿童继发性高血压在极少数情况下可由内分泌因素引起，如嗜铬细胞瘤，一种分泌儿茶酚胺的肾上腺肿瘤。在过去30年中仅报道了少数病例。据我们所知，这是印度尼西亚首例儿童嗜铬细胞瘤病例报告。我们回顾了一例16岁的印度尼西亚男孩，他有隐匿性高血压危象病史，从一个岛屿的偏远地区转诊至印度尼西亚雅加达Cipto Mangunkusumo医院的儿科肾病诊所。尽管进行了药物治疗，他的症状仍持续了14个月。在儿科肾病诊所，由于出现了儿茶酚胺分泌症状，即心悸、多汗和体重减轻，怀疑为嗜铬细胞瘤。然而，由于印度尼西亚无法进行尿儿茶酚胺检测，尿液样本被送往国外的一家实验室。尿间甲肾上腺素水平升高、I-MIBG显示右肾上腺肿块有局灶性病理摄取以及组织病理学检查证实了嗜铬细胞瘤的怀疑。肿瘤切除后，他在未服用抗高血压药物的情况下血压一直正常。该病例强调，嗜铬细胞瘤应始终纳入任何非典型高血压表现的鉴别诊断中。在资源有限的情况下，需要对嗜铬细胞瘤有高度的临床认识以促进及时转诊。怀疑嗜铬细胞瘤后应测量尿间甲肾上腺素水平。嗜铬细胞瘤的早期诊断将加快最佳治疗，缓解儿茶酚胺释放症状，并逆转高血压。
