Babiker Amir, Al Hamdan Wejdan, Kinani Sondos, Kazzaz Yasser, Habeb Abdelhadi, Al Harbi Talal, Al Dubayee Mohammed, Al Namshan M, Attasi Abdul Aleem
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
King Abdullah Specialized Children Hospital, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia.
Endocrinol Diabetes Metab Case Rep. 2021 Jul 19;2021(20-0101):EDM200101. doi: 10.1530/EDM-20-0101.
The use of antihypertensive medications in patients with pheochromocytomas and paragangliomas (PCC/PG) is usually a challenge. We report a case of familial paraganglioma that was successfully treated by esmolol and other antihypertensive medications without associated perioperative complications. Our patient was an 11-year-old girl who presented with classic symptoms and signs of PCC/PG and a CT scan of the abdomen that showed a right-sided paravertebral mass. Her father was diagnosed with paraganglioma a few years ago. Prazosin had been started but she continued to experience uncontrolled paroxysms of blood pressure (BP). She was known to have asthma; hence, she developed serious bronchospasm with atenolol. She was, therefore, switched to esmolol that successfully controlled her BP in addition to prazosin and intermittent doses of hydralazine prior to laparoscopic surgery with no side effects of medications or postoperative complications. Esmolol could be a good alternative to routinely used beta-blockers in children with PCC/PG with labile hypertension and related symptoms in the pre and intra-operative periods. It is titrable, effective, and can be weaned rapidly helping to avoid postoperative complications. Further larger studies on the use of esmolol in children with PCC/PG are needed to confirm our observation.
In addition to alpha-blockers, esmolol could be a good alternative for routinely used beta-blockers to control paroxysmal hypertension and tachycardia in the pre- and intra-operative periods. Esmolol is titrable and an effective beta-blocker. It can be weaned rapidly helping to avoid postoperative complications in children with PCC/PG. Children with PCC/PG and other comorbidity like asthma may particularly benefit from the use of esmolol due to no or less side effects on airway resistance and the advantage of rapid titration of the medication compared to other beta-blockers.
在嗜铬细胞瘤和副神经节瘤（PCC/PG）患者中使用抗高血压药物通常具有挑战性。我们报告了一例家族性副神经节瘤病例，该病例通过艾司洛尔和其他抗高血压药物成功治疗，且未出现围手术期并发症。我们的患者是一名11岁女孩，表现出PCC/PG的典型症状和体征，腹部CT扫描显示右侧椎旁肿块。她的父亲几年前被诊断为副神经节瘤。已开始使用哌唑嗪，但她仍持续经历血压（BP）阵发性失控。已知她患有哮喘；因此，使用阿替洛尔时她出现了严重的支气管痉挛。因此，在腹腔镜手术前，她改用艾司洛尔，除哌唑嗪和间歇剂量的肼屈嗪外，艾司洛尔成功控制了她的血压，且未出现药物副作用或术后并发症。对于术前和术中血压不稳定及有相关症状的PCC/PG儿童患者，艾司洛尔可能是常规使用的β受体阻滞剂的良好替代品。它可滴定、有效，且能迅速撤药，有助于避免术后并发症。需要进一步对艾司洛尔在PCC/PG儿童患者中的应用进行更大规模的研究以证实我们的观察结果。
除α受体阻滞剂外，艾司洛尔可能是常规使用的β受体阻滞剂在术前和术中控制阵发性高血压和心动过速的良好替代品。艾司洛尔可滴定且是一种有效的β受体阻滞剂。它能迅速撤药，有助于避免PCC/PG儿童患者出现术后并发症。患有PCC/PG且有其他合并症如哮喘的儿童可能特别受益于艾司洛尔的使用，因为与其他β受体阻滞剂相比，它对气道阻力无副作用或副作用较小，且具有药物快速滴定的优势。
