title: Treatment of Hypertension in Children With Catecholamine-Secreting Tumors: A Systematic Approach.
abstract: Management of blood pressure in children with pheochromocytoma and other catecholamine-secreting tumors (CSTs) is unique and challenging. The authors report a single-center experience using sequential α-adrenergic blockade (phenoxybenzamine), increased fluid intake, and β-blockade for presurgical management of 10 CSTs in children. In this retrospective review, mean duration for blood pressure control in preparation for surgery was 4.5±2.6 weeks. Intraoperative hypertension was noted transiently (<2 hours) in eight patients (80%) and was treated with continuous infusion of short-acting antihypertensive agents. Two (20%) patients required vasopressor medication infusion to manage intraoperative hypotension. Only two (20%) patients developed postoperative hypotension and required vasopressor medication infusion for <24 hours. All antihypertensive medications were discontinued in the immediate (≤4 days) postoperative period in 80% of patients. In conclusion, a systematic and multidisciplinary approach utilizing adrenergic blockade is effective in treating children with CSTs.
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Romero
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kapur
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Rossana
authors.initials: R
authors.lastname: Baracco
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Rudolph P
authors.initials: RP
authors.lastname: Valentini
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Tej K
authors.initials: TK
authors.lastname: Mattoo
authors.affiliation: Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Amrish
authors.initials: A
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002395:Catecholamines / Q000097:blood / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D007022:Hypotension / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D010643:Phenoxybenzamine / Q000627:therapeutic use*; D010673:Pheochromocytoma / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D051794:Von Hippel-Lindau Tumor Suppressor Protein / Q000378:metabolism
chemical_list: D000317:Adrenergic alpha-Antagonists; D000959:Antihypertensive Agents; D002395:Catecholamines; D010643:Phenoxybenzamine; D051794:Von Hippel-Lindau Tumor Suppressor Protein; C497446:VHL protein, human