Islam Shariful, Ramoutar Joshua, Ramnarine Malini, Ramadan Raphael, Dan Dilip
Department of Surgery, San Fernando General Hospital, San Fernando, TTO.
Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.
Cureus. 2025 Jun 23;17(6):e86623. doi: 10.7759/cureus.86623. eCollection 2025 Jun.
Malignant hypertension is defined as extremely elevated blood pressure (BP) with or without target organ damage. It can be either hypertensive urgency, characterized as malignant hypertension without any clear evidence of immediate organ damage, or hypertensive emergency with proof of new or worsening target-organ damage. The modern definition of hypertensive emergencies without retinopathy would be based on the presence of acutely raised BP with injury to at least three target organs. Pheochromocytoma is the rarest cause of malignant arterial hypertension, characterized by the classic triad of headache, sweating, and palpitations. It is rare in adolescents, and it often presents a unique surgical challenge due to catecholamine secretion. Laparoscopic adrenalectomy is the recommended surgical treatment of choice. Although it is a common procedure performed in adults, it has not yet been reported in adolescents in the Caribbean. This case report details the presentation of a 16-year-old boy from Trinidad and Tobago, who had a six-month history of episodic headaches, sweating, palpitations, blurry vision, and significantly elevated BP (up to 225/120 mmHg). His clinical picture was further complicated by new-onset diabetes mellitus and a family history of hypertension and diabetes on both maternal and paternal sides. Investigations revealed significantly elevated catecholamine levels, and imaging confirmed a right adrenal mass consistent with a pheochromocytoma. This case highlights both the clinical complexity and the feasibility of performing laparoscopic adrenalectomy in adolescent patients within a Caribbean healthcare setting.
恶性高血压的定义为血压极度升高，伴有或不伴有靶器官损害。它可以是高血压急症，即无任何明确的即时器官损害证据的恶性高血压，也可以是有新的或恶化的靶器官损害证据的高血压急症。无视网膜病变的高血压急症的现代定义将基于急性血压升高且至少三个靶器官受损。嗜铬细胞瘤是恶性动脉高血压最罕见的病因，其特征为头痛、出汗和心悸的典型三联征。它在青少年中罕见，由于儿茶酚胺分泌，它常常带来独特的手术挑战。腹腔镜肾上腺切除术是推荐的首选手术治疗方法。虽然这是在成人中常见的手术，但在加勒比地区青少年中尚未见报道。本病例报告详细介绍了一名来自特立尼达和多巴哥的16岁男孩的情况，他有6个月的发作性头痛、出汗、心悸、视力模糊和血压显著升高（高达225/120 mmHg）的病史。他的临床情况因新发糖尿病以及父母双方的高血压和糖尿病家族史而更加复杂。检查显示儿茶酚胺水平显著升高，影像学检查证实右侧肾上腺肿块与嗜铬细胞瘤一致。本病例突出了加勒比地区医疗环境下青少年患者腹腔镜肾上腺切除术的临床复杂性和可行性。
