Stress hyperglycaemia as a result of a catecholamine producing tumour in an infant
Anne Mariëtte de Grauw1, Dick Mul2, Max M van Noesel3
1Department of Pediatrics, HAGAziekenhuis/Juliana Children's Hospital, The Hague, The Netherlands.
Insights
Stress-induced hyperglycemia in children is usually benign. However, this case highlights a rare neuroblastoma in an infant, where hyperglycemia was the initial symptom, indicating a serious underlying condition.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Neuroendocrine Tumors
Background:
- Hyperglycemia in children presenting to the emergency department is often stress-related and considered benign.
- This case examines a rare instance where hyperglycemia was the first sign of a malignant neuroendocrine tumor.
Observation:
- An 11-month-old girl presented with hyperglycemia (234 mg/dL), elevated glycosylated hemoglobin (44 mmol/mol), sweating, flushing, hypertension, and tachypnea.
- Urinalysis revealed high levels of catecholamine intermediates, and an abdominal ultrasound identified a right adrenal gland mass.
Findings:
- Histological examination confirmed the diagnosis of neuroblastoma, a metabolically active neuroendocrine malignancy.
- The patient experienced periods of hyperglycemia, sweating, flushing, hypertension, and tachypnea, consistent with catecholamine excess.
Implications:
- This case underscores the importance of investigating persistent or unusual hyperglycemia in children, even in the absence of typical diabetic symptoms.
- It highlights neuroblastoma as a potential, albeit rare, cause of significant hyperglycemia in pediatric patients.
- Early recognition of hyperglycemia as a presenting symptom can lead to timely diagnosis and treatment of pediatric neuroendocrine malignancies.
Abstract:
Hyperglycaemia commonly occurs in children presenting at the emergency department. In the absence of diabetic symptoms, this stress-related hyperglycaemia is considered a benign condition. We present a malignant cause of hyperglycaemia in an 11-month-old girl with concomitant symptoms of a neuroendocrine malignancy. One month earlier, she had undergone an episode of stress-related hyperglycaemia concurrent with fever during an upper respiratory tract infection. Current glucose level was 234 mg/dL (13 mmol/L) and the glycosylated haemoglobin level was 44 mmol/mol (6.2%) without metabolic acidosis. We observed periods of hyperglycaemia, sweating, flushing, hypertension and tachypnoea. Urinalysis showed high amounts of catecholamine intermediates. Abdominal ultrasound revealed a mass originating in the right adrenal gland. Histology confirmed the diagnosis of neuroblastoma. Hyperglycaemia in this patient was the first presenting symptom of a metabolically active neuroblastoma.
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