Attention Deficit Hyperactivity Disorder in Pediatric Patients with Pheochromocytoma and Paraganglioma
M Batsis1, U Dagalakis1, C A Stratakis1
1Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Insights
Pediatric pheochromocytoma/paraganglioma (PHEO/PGL) patients show a significantly higher prevalence of attention deficit hyperactivity disorder (ADHD). Early evaluation for PHEO/PGL is crucial in children with hypertension and ADHD symptoms.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Neuro-oncology
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Pheochromocytoma/paraganglioma (PHEO/PGL) are rare neuroendocrine tumors.
- The association between ADHD and PHEO/PGL in pediatric patients remains under-explored.
Purpose of the Study:
- To investigate the association between ADHD and PHEO/PGL in pediatric patients.
- To determine the prevalence of ADHD in pediatric patients diagnosed with PHEO/PGL.
- To assess the impact of PHEO/PGL treatment on ADHD symptoms.
Main Methods:
- A case series of 43 pediatric patients with PHEO/PGL tumors evaluated at the National Institute of Health (2006-2014).
- Review of prior ADHD diagnosis, stimulant medication treatment, patient symptoms, catecholamine/metanephrine levels, tumor characteristics, and genetic analyses.
- Chi-squared test used to compare ADHD prevalence in PHEO/PGL patients versus the general pediatric population.
Main Results:
- Nine out of 43 (21%) pediatric PHEO/PGL patients had a prior ADHD diagnosis, significantly higher than the general population prevalence (7.2%).
- Four patients received stimulant medications (amphetamine, dextroamphetamine, methylphenidate), potentially risking adrenergic crisis.
- Four patients presented with hypertension; three experienced ADHD symptom resolution post-PHEO/PGL tumor resection.
Conclusions:
- Pediatric patients with PHEO/PGL exhibit a significantly higher prevalence of ADHD.
- Hypertension and ADHD symptomatology in children warrant evaluation for PHEO/PGL before initiating stimulant therapy.
- Unrecognized PHEO/PGL may contribute to ADHD-like symptoms such as anxiety and concentration difficulties.
Abstract:
The aim of the study is to evaluate if there is an association between attention deficit hyperactivity disorder (ADHD) and the diagnosis of pheochromocytoma/paraganglioma (PHEO/PGL) in pediatric patients. A case series study of 43 patients under the age of 18 with PHEO/PGL tumors who were evaluated at the National Institute of Health between January 2006 and May 2014 is reported. Prior diagnosis of ADHD and treatment course with stimulant medications was recorded. Patient symptoms, catecholamine and metanephrine levels, tumor characteristics, and genetic analyses for syndromes associated with PHEO/PGL were evaluated. A chi-squared test was used to assess the prevalence of ADHD in the PHEO/PGL patients compared to the general population. Nine out of 43 (21%) of patients diagnosed with PHEO/PGL had been diagnosed with ADHD prior to tumor identification. Four of the 9 patients had been treated with amphetamine, dextroamphetamine, and/or methylphenidate, potentially exacerbating an adrenergic crisis. In addition, 4 patients exhibited hypertension at the initial diagnosis of their PHEO/PGL. Three patients had resolution of their ADHD symptoms after successful surgical removal of PHEO/PGL. Our study found a prevalence of ADHD in 21% of our PHEO/PGL patients, significantly higher than 7.2% seen in the general pediatric population. Symptoms of anxiety and difficulty in concentration in these patients may have been related to their underlying PHEO/PGL and were not recognized as part of the constellation of symptoms in a child with PHEO/PGL. In pediatric patients with hypertension and ADHD symptomatology, an evaluation to rule out PHEO/PGL is warranted prior to treatment with stimulant medications.
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