Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
Division of Pediatric Nephrology, Department of Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Curr Hypertens Rep. 2021 May 27;23(5):32. doi: 10.1007/s11906-021-01150-9.
The rare catecholamine-secreting tumors, pheochromocytomas and paragangliomas (PPGL), account for a minority of cases of secondary hypertension in pediatrics. As such, perioperative blood pressure (BP) management in pediatric patients presents a distinct challenge. This review will expand the practitioner's knowledge of antihypertensive treatment options for the pediatric patient with PPGL with a focus on literature in the past several years.
There continue to be only small case series and single-center experiences to provide guidelines regarding BP management. While phenoxybenzamine has been more routinely used, selective α-blockers, such as doxazosin, as well as calcium channel blockers, have also been utilized with success in pediatric patients. While the concept of obligatory α-adrenergic blockade for adult patients has been recently challenged, international guidelines and current practice patterns among pediatric clinicians continue to support preoperative α-adrenergic blockade to ensure the best possible patient outcomes. Selective α-blockers and calcium channel blockers are becoming more commonly used given the high cost, limited availability, and undesirable side effect profile of phenoxybenzamine.
罕见的儿茶酚胺分泌肿瘤，即嗜铬细胞瘤和副神经节瘤（PPGL），仅占儿科继发性高血压病例的少数。因此，儿科患者围手术期血压（BP）管理带来了独特的挑战。本综述将扩展从业者对儿科 PPGL 患者降压治疗选择的知识，重点关注近年来的文献。
目前仍然只有小的病例系列和单中心经验，为 BP 管理提供指南。虽然苯氧苄胺的应用更为常规，但选择性α-阻滞剂，如多沙唑嗪，以及钙通道阻滞剂，也已成功应用于儿科患者。虽然成人患者强制性α-肾上腺素能阻滞的概念最近受到了挑战，但国际指南和儿科临床医生的当前实践模式仍然支持术前α-肾上腺素能阻滞，以确保患者获得最佳结果。鉴于苯氧苄胺的高成本、有限的可用性和不良的副作用，选择性α-阻滞剂和钙通道阻滞剂的应用越来越普遍。
