Treatment of Hypertension in Children With Catecholamine-Secreting Tumors: A Systematic Approach
Mauricio Romero1, Gaurav Kapur1, Rossana Baracco1
1Division 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.
Insights
Managing blood pressure in children with catecholamine-secreting tumors (CSTs) requires a specific approach. Sequential alpha-adrenergic blockade, fluid intake, and beta-blockade effectively control blood pressure before surgery for pediatric CSTs.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Cardiovascular Pharmacology
Background:
- Pheochromocytoma and catecholamine-secreting tumors (CSTs) present unique challenges in pediatric blood pressure management.
- Preoperative blood pressure control is critical for surgical safety in children with CSTs.
Purpose of the Study:
- To evaluate the efficacy of a presurgical management strategy for pediatric patients with CSTs.
- To assess blood pressure control and perioperative hemodynamic stability in children undergoing treatment for CSTs.
Main Methods:
- A retrospective review of 10 pediatric patients with CSTs.
- Sequential alpha-adrenergic blockade (phenoxybenzamine), increased fluid intake, and beta-blockade were used for presurgical management.
- Continuous infusion of antihypertensive and vasopressor agents was utilized as needed during surgery.
Main Results:
- Mean duration for blood pressure control was 4.5±2.6 weeks.
- Eighty percent of patients experienced transient intraoperative hypertension, managed with antihypertensives.
- Twenty percent required vasopressors for intraoperative or postoperative hypotension (<24 hours).
- Eighty percent of patients discontinued antihypertensive medications within 4 days post-surgery.
Conclusions:
- A systematic, multidisciplinary approach using adrenergic blockade is effective for presurgical management of pediatric CSTs.
- This strategy facilitates effective blood pressure control and hemodynamic stability during the perioperative period.
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.
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