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Pheochromocytoma diagnosed in an enuretic boy after imipramine-induced hypertension
1Department of Paediatrics, Herning Hospital, Denmark.
Insights
A 14-year-old boy developed hypertension from pheochromocytoma, a rare tumor, after imipramine treatment. This suggests cyclic antidepressants can unmask such tumors by inhibiting catecholamine reuptake.
Area of Science:
- Pediatric Endocrinology
- Clinical Pharmacology
- Oncology
Background:
- Primary nocturnal enuresis is common in children and often treated with medications like imipramine.
- Imipramine, a tricyclic antidepressant, affects neurotransmitter reuptake, including catecholamines.
- Pheochromocytoma is a rare neuroendocrine tumor causing excess catecholamine release.
Observation:
- A 14-year-old male presented with new-onset hypertension.
- The hypertension developed during treatment with imipramine for nocturnal enuresis.
- Diagnostic workup revealed a pheochromocytoma.
Findings:
- The patient's hypertension was attributed to the pheochromocytoma.
- Imipramine's mechanism of action, inhibiting neuronal catecholamine uptake, likely exacerbated the effects of tumor-released catecholamines.
- This interaction led to clinically significant hypertension.
Implications:
- Pheochromocytoma should be considered in the differential diagnosis of new-onset hypertension in patients, particularly children, treated with cyclic antidepressants.
- Clinicians should be aware of the potential for drug-tumor interactions involving catecholamine metabolism.
- Early diagnosis and management of pheochromocytoma are crucial to prevent severe cardiovascular complications.
Abstract:
A pheochromocytoma was diagnosed in a 14-year-old boy developing hypertension after treatment with imipramine for primary nocturnal enuresis. The mechanism of action is assumed to be an inhibition of the neuronal uptake of catecholamines being released in large quantities from the tumor. The diagnosis of pheochromocytoma should be considered in patients developing hypertension during treatment with cyclic antidepressants.