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2017 ; 5
(ä): 155
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Review of Pediatric Pheochromocytoma and Paraganglioma
#MMPMID28752085
Bholah R
; Bunchman TE
Front Pediatr
2017[]; 5
(ä): 155
PMID28752085
show ga
Pheochromocytoma (PCC) and paraganglioma (PGL) are rare chromaffin cell tumors
which secrete catecholamines and form part of the family of neuroendocrine
tumors. Although a rare cause of secondary hypertension in pediatrics, the
presentation of hypertension in these patients is characteristic, and treatment
is definitive. The gold standard for diagnosis is via measurement of plasma free
metanephrines, with imaging studies performed for localization, identification of
metastatic lesions and for surgical resection. Preoperative therapy with
alpha-blocking agents, beta blockers, and potentially tyrosine hydroxylase
inhibitors aid in a safe pre-, intra- and postoperative course. PCC and PGL are
inherited in as much as 80% of pediatric cases, and all patients with mutations
should be followed closely given the risk of recurrence and malignancy. While the
presentation of chromaffin cell tumors has been well described with multiple
endocrine neoplasia, NF1, and Von Hippel-Lindau syndromes, the identification of
new gene mutations leading to chromaffin cell tumors at a young age is changing
the landscape of how clinicians approach such cases. The
paraganglioma-pheochromocytoma syndromes (SDHx) comprise familial gene mutations,
of which the SDHB gene mutation carries a high rate of malignancy. Since the
inheritance rate of such tumors is higher than previously described, genetic
screening is recommended in all patients, and lifelong follow-up for recurrent
tumors is a must. A multidisciplinary team approach allows for optimal
health-care delivery in such children. This review serves to provide an overview
of pediatric PCC and PGL, including updates on the preferred methods of imaging,
guidelines on gene testing as well as management of hypertension in such
patients.