title: Hypertensive retinopathy in a child caused by pheochromocytoma: identification after a failed school vision screening.
abstract: A 7-year-old girl was referred for ophthalmological examination after the result of a routine school vision screening identified unilateral vision loss. Fundus examination showed bilateral but markedly asymmetric macular exudates and optic disk edema. After the results of two blood pressure measurements were within normal limits, a third markedly elevated measurement revealed malignant hypertension and led to a diagnosis of pheochromocytoma, a rare catecholamine-secreting tumor. The tumor was resected, and 6 months later the patient's blood pressure had normalized; however, although visual acuity had improved to 20/20 in the right eye, it remained 20/200 in the left eye, with decreased disk edema but the persistence of the macular exudates. The identification of an abdominal malignancy through a school vision screening may have saved this child's life. The need for repeated blood pressure measurement is also highlighted.
authors.affiliation: Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5109, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Tibbetts
authors.forename: Richard
authors.initials: R
authors.lastname: Wise
authors.forename: Brian
authors.initials: B
authors.lastname: Forbes
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.forename: Alex V
authors.initials: AV
authors.lastname: Levin
mesh_terms: D019797:3-Iodobenzylguanidine; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis; D002648:Child; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058437:Hypertensive Retinopathy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis; D019275:Radiopharmaceuticals; D014786:Vision Disorders / Q000209:etiology*; D015351:Vision Screening; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine