Rodd C J, Sockalosky J J
Division of Endocrinology and Metabolism, University of Minnesota, Minneapolis.
Pediatr Clin North Am. 1993 Feb;40(1):149-64. doi: 10.1016/s0031-3955(16)38487-5.
Hypertension in children is not a common problem. When it is found, however, a pathologic cause can often be identified. The endocrine causes of hypertension in children are generally rare. We have reviewed the diverse and rare endocrine causes of hypertension in the pediatric population. Table 3 lists features of these conditions that assist in their diagnosis. In all patients with hypertension, a thorough history and physical examination may point to the diagnosis of endocrine or other causes of secondary hypertension. For a more detailed approach to these diagnoses, other reviews may be helpful. A phased laboratory evaluation similar to that suggested by Ogborn and Crocker facilitates in the evaluation of secondary hypertension. The critical screening tests from an endocrine point of view are plasma sodium, potassium, calcium, renin activity, and thyroid function tests, including T4, T3, and thyroid stimulating hormone. Measurement of a 24-hour urine collection for aldosterone, metanephrine, and catecholamines may be warranted if the previously mentioned studies are unrevealing. More specific studies also may be suggested by these preliminary evaluations and the history and physical examination. Further investigations should be done with the additional guidance of a pediatric endocrinologist.
儿童高血压并非常见问题。然而，一旦发现，往往能够确定其病理原因。儿童高血压的内分泌病因通常较为罕见。我们回顾了儿科人群中各种罕见的高血压内分泌病因。表3列出了有助于诊断这些病症的特征。对于所有高血压患者，全面的病史和体格检查可能指向继发性高血压的内分泌或其他病因诊断。对于这些诊断的更详细方法，其他综述可能会有所帮助。类似于奥格本和克罗克所建议的分阶段实验室评估有助于继发性高血压的评估。从内分泌角度来看，关键的筛查测试包括血浆钠、钾、钙、肾素活性以及甲状腺功能测试，包括T4、T3和促甲状腺激素。如果上述研究无异常发现，可能需要检测24小时尿醛固酮、间甲肾上腺素和儿茶酚胺。这些初步评估以及病史和体格检查也可能提示更具体的研究。应在儿科内分泌专家的额外指导下进行进一步调查。
