Captopril test: time over?

Lenz, Tomas; KIa, Ter-Voskanian; Rupprecht, Gerhard; Schulte, Karl-Ludwig; Geiger, Helmut

doi:10.1038/sj.jhh.1000860

Cited by 17 publications

(8 citation statements)

References 29 publications

(22 reference statements)

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“…Other specific diagnostic procedures are also available to investigate affected individuals [44,47], but experience in their use in children is limited. Nonimaging tests include measurement of peripheral plasma renin activity [48], the captopril test [49] and renal vein renin sampling [50], all of which have inherent limitations. ACE inhibition renal scintigraphy has been proven to be a useful initial screening test [51,52].…”

Section: Etiological Classification Of Elevated Bpmentioning

confidence: 99%

A diagnostic approach for the child with hypertension

Varda

Gregorič

2005

Pediatr Nephrol

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Hypertension during childhood is not rare, with an estimated prevalence of between 1% and 2%, although it is often an underrecognized clinical entity. Elevated blood pressure may be a sign of underlying disease or it may represent early onset of essential hypertension. In recent years the measurement of blood pressure has been emphasized as an important component of the routine pediatric physical examination that enables early detection of children with hypertension. In the evaluation of the child with documented blood pressure elevation, confirmation of truly and persistently elevated blood pressure is of the utmost importance. In addition, a thorough history and a full clinical examination are essential. These are followed by appropriate investigations, which are tailored to the age of the child and to the severity of the blood pressure elevation. Investigations should not only focus on a search for the underlying cause, but also on establishing effects on target organs, complications or additional diseases and on assessment of the total cardiovascular risk to the individual patient. An algorithm, which is a valuable diagnostic tool for the diagnosis and management of the child with hypertension, is presented. All children with confirmed hypertension need long-term follow-up, counseling and treatment. In those cases where an underlying cause of the hypertension is detected, the established diagnosis then determines the specific therapy and management.

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Section: Etiological Classification Of Elevated Bpmentioning

confidence: 99%

A diagnostic approach for the child with hypertension

Varda

Gregorič

2005

Pediatr Nephrol

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“…Measurement of peripheral plasma renin activity and its reactive rise after captopril (captopril test) are screening tests that assess the renin dependency of hypertension and so indicate the hypertensive patients who need subsequent investigation. Available data suggest that the captopril test has a limited diagnostic accuracy as a screening test for the detection of RVH [23].…”

Section: Discussionmentioning

confidence: 99%

Captopril scintigraphy in the study of arterial hypertension in pediatrics

Lagomarsino

Orellana

Muñoz

et al. 2004

Pediatric Nephrology

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Renovascular hypertension (RVH) is responsible for 10% of arterial hypertension in children. The early diagnosis of RVH permits specific treatment leading to the cure of hypertension and avoidance of parenchymal damage. Captopril renal scintigraphy (CRS) provides information on the renovascular cause of the arterial hypertension. To validate the usefulness of CRS in hypertensive children, clinical, scintigraphic, and radiological data from 20 patients (mean age 6.1+/-5.5 years) were reviewed. Two patients were newborns. All had renal ultrasound scans and 9 had aortograms. In 7 children, RVH was confirmed by angiography, and CRS was positive for RVH in 6 of these. CRS was negative for RVH in 12 of 13 children without RVH. CRS was non-diagnostic in 3 children with abnormal baseline renal scintigraphy and severely decreased relative renal function ( <35%), 1 of whom had RVH. No side effects of captopril renography were observed. Captopril renography provides a logical, non-invasive, safe, and cost-effective approach in the evaluation of children suspected of having RVH.

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“…In a clinically suspected pheochromocytoma, the diagnosis is confirmed by measurements of urinary and plasma catecholamines and their metabolites, followed by radiological evaluation to locate the tumor [1][2][3][4][5][6]8 . Most patients with clinically evident tumors have clearly abnormal values in any of the commonly used tests.…”

Section: Intoductionmentioning

confidence: 99%

“…Exclusively dopamine-producing tumors are extremely rare. Elevations in plasma or urinary dopamine, however, should arouse suspicion of metastatic disease, although it is not a particularly sensitive or specific marker of malignancy 6,7 .…”

Section: Intoductionmentioning

confidence: 99%

Symptomatic pheochromocytoma with normal urinary catecholamine metabolites

Zianni

Tzanela²,

Klimopoulos³

et al. 2004

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A 61-year old female presented with paroxysmal hypertension and a 4.5cm left adrenal mass on CT scan. Repeated measurements of 24-hour urinary fractionated metanephrines, total catecholamines and vanillylmandelic acid (VMA) were within normal range. A further scintigraphic study with 131 I -metaiodobenzylguanidine ( 131 I-MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. After adequate preoperative treatment, successful surgical excision of the tumor was performed and the pathological examination confirmed the diagnosis of a cystic pheochromocytoma with a 2cm solid tumor. On reevaluation three months later using 131 I-MIBG, no evidence of remaining or recurrent disease was found. The patient, off any antihypertensive medication, reported mild recurrent hypertension and panic attacks that were adequately controlled with antidepressants. This is a rare case of a symptomatic pheochromocytoma without elevated urine catecholamines and metanephrines. According to the literature, plasma free metanephrines would be the ideal test for biochemical detection of the tumor. However, in the event that they are not available and there is a high clinical suspicion for the presence of pheochromocytoma, as in our patient, we suggest performance of a functional nuclear medicine study, such as 131 I-MIBG, to confirm the clinical diagnosis.

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Captopril test: time over?

Cited by 17 publications

References 29 publications

A diagnostic approach for the child with hypertension

A diagnostic approach for the child with hypertension

Captopril scintigraphy in the study of arterial hypertension in pediatrics

Symptomatic pheochromocytoma with normal urinary catecholamine metabolites

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