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Endocrine causes of hypertension in children
1Division of Endocrinology and Metabolism, University of Minnesota, Minneapolis.
Insights
Pediatric hypertension often has an identifiable cause, with rare endocrine conditions being a focus. Early diagnosis through history, physical exams, and specific lab tests is crucial for managing childhood high blood pressure.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Internal Medicine
Background:
- Hypertension in children is uncommon but frequently linked to identifiable pathological causes.
- Endocrine origins of pediatric hypertension are rare but significant.
- Secondary hypertension in children warrants thorough investigation.
Purpose of the Study:
- To review diverse and rare endocrine causes of hypertension in the pediatric population.
- To outline diagnostic features and evaluation strategies for pediatric hypertension.
Main Methods:
- Comprehensive review of literature on pediatric endocrine hypertension.
- Emphasis on diagnostic clues from patient history and physical examination.
- Phased laboratory evaluation including plasma electrolytes, renin activity, thyroid function, and 24-hour urine collections for specific hormones.
Main Results:
- Specific endocrine conditions present unique diagnostic features detailed in diagnostic aids.
- Initial laboratory screening includes plasma sodium, potassium, calcium, renin activity, and thyroid function tests (T4, T3, TSH).
- Further investigations like 24-hour urine collections for aldosterone, metanephrine, and catecholamines may be necessary.
Conclusions:
- A systematic approach combining clinical assessment and phased laboratory testing is essential for diagnosing endocrine hypertension in children.
- Consultation with a pediatric endocrinologist is recommended for complex cases and further investigations.
Abstract:
Hypertension in children is not a common problem. When it is found, however, a pathologic cause can often be identified. The endocrine causes of hypertension in children are generally rare. We have reviewed the diverse and rare endocrine causes of hypertension in the pediatric population. Table 3 lists features of these conditions that assist in their diagnosis. In all patients with hypertension, a thorough history and physical examination may point to the diagnosis of endocrine or other causes of secondary hypertension. For a more detailed approach to these diagnoses, other reviews may be helpful. A phased laboratory evaluation similar to that suggested by Ogborn and Crocker facilitates in the evaluation of secondary hypertension. The critical screening tests from an endocrine point of view are plasma sodium, potassium, calcium, renin activity, and thyroid function tests, including T4, T3, and thyroid stimulating hormone. Measurement of a 24-hour urine collection for aldosterone, metanephrine, and catecholamines may be warranted if the previously mentioned studies are unrevealing. More specific studies also may be suggested by these preliminary evaluations and the history and physical examination. Further investigations should be done with the additional guidance of a pediatric endocrinologist.