Cerebral ischaemic stroke and bilateral pheochromocytoma

Abourazzak, S.; Atmani, S.; Arqam, Larbi El; Chaouki, S.; Labib, Smael; Harrandou, Moustapha; Tizniti, S.; Bouabdellah, Youssef; Bouharrou, Abdelhak; Hida, M.

doi:10.1136/bcr.12.2009.2535

Cited by 11 publications

(11 citation statements)

References 6 publications

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“…Neurologic complications are usually caused by changes in blood pressure and include episodic headaches, and ischemic or haemorrhagic cerebrovascular events have been reported in the paediatric literature [ 105 – 107 ]. Furthermore, it is important to be cognisant of the possibility of posterior reversible encephalopathy syndrome (PRES) in children with pheochromocytoma or paraganglioma presenting with hypertension and cerebrovascular manifestations [ 108 ].…”

Section: Disorders Of the Adrenal Medulla And The Paediatric Brainmentioning

confidence: 99%

Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

Salpietro

Polizzi

Rosa

et al. 2014

International Journal of Endocrinology

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Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency) has been reported with neurological and magnetic resonance imaging (MRI) abnormalities (e.g., delayed myelination and brain atrophy) due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH), a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF) pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS) through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric) CNS seems to be particularly vulnerable to alterations induced by adrenal disorders and/or supraphysiological doses of corticosteroids. Physicians should be aware of potential neurological manifestations in children with adrenal dysfunction to achieve better prevention and timely diagnosis and treatment of these disorders. Further studies are needed to explore the potential neurological, cognitive, and psychiatric long-term consequences of high doses of prolonged corticosteroid administration in childhood.

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Section: Disorders Of the Adrenal Medulla And The Paediatric Brainmentioning

confidence: 99%

Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

Salpietro

Polizzi

Rosa

et al. 2014

International Journal of Endocrinology

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“…Persistently high levels of arterial blood pressure may lead to the development of complications such as hypertensive cardiomyopathy or retinopathy and retinal detachment. Other complications that may occur in the course of phaeochromocytoma include myocardial infarction and heart failure, arrhythmia, stroke, sudden cardiac death, and, less frequently, Takotsubo cardiomyopathy and adrenergic myocarditis [32,33,34,35,36,37,38]. …”

Section: Clinical Classificationmentioning

confidence: 99%

Von Hippel-Lindau Syndrome

Beń‐Skowronek

Kozaczuk²

2015

Horm Res Paediatr

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Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome characterized by the development of multiple vascular tumours. The syndrome is caused by inactivation of the VHL protein (pVHL) and increased production of VEGF, PDGF, and TGF-α. The course of VHL syndrome is associated with the development of multiple vascular tumours. Most frequently, these include retinal and central nervous system haemangioblastomas, clear cell renal cell carcinoma, phaeochromocytomas, pancreatic islet tumours, endolymphatic sac tumours, and additionally, renal and pancreatic cystadenomas and epididymal cystadenomas in men. VHL syndrome is a highly complex disease; hence, the diagnosis is often difficult. The diagnosis of any of the characteristic tumours, particularly in children, is an implicit indication for the necessity of diagnosis and genetic tests in the patient and family members and for intensive supervision of carriers of the mutated gene, thereby improving early diagnosis and successful treatment of the malignancies.

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“…5 Various stroke symptoms were reported in single patients or small case series with conditions where elevated BP was clearly associated with, or was an important risk factor in underlying conditions. 31,[33][34][35][36][37][38][39][40][41][42][43][44] We have identified multiple barriers to recognize the contribution of elevated BP to the development of stroke in childhood. Case series and review articles on pediatric stroke often did not mention elevated BP as a potential risk factor 45,46 (except in sickle cell disease, where it is a risk factor for both ischemic and hemorrhagic stroke).…”

Section: Hypertension and Stroke: Definitions Barriers And Limimentioning

confidence: 99%

“…The development of a pheochromocytoma is another risk factor predisposing to hypertension and, in selective cases, to stroke. 42 Tuberous Sclerosis Complex (TSC) is an autosomal-dominant neurocutaneous disease characterized by widespread hamartomas and benign or rarely malignant neoplasms affecting various organs. 81,82 Renal involvement is present in more than 50% of cases, most commonly renal angiomyolipomas or cysts.…”

Section: Stroke and Sickle Cell Diseasementioning

confidence: 99%

Stroke and Hypertension in Children and Adolescents

et al. 2016

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Hypertension is the single most important modifiable risk factor for adult stroke. Stroke mortality has significantly decreased over the last 5 decades; this decline has been mainly associated to improved blood pressure control. Though much less prevalent than in adults, stroke is an increasingly recognized cause of morbidity and mortality in children. Although hypertension has not been strongly identified as a risk factor in childhood stroke yet, there is preliminary evidence that suggests that elevated blood pressure may be associated with stroke in children. This review summarizes the literature that may link elevated blood pressure to the development of childhood ischemic and hemorrhagic stroke. The authors suggest that elevated blood pressure may be a significant risk factor that, alone or in combination with other multiple risk factors, leads to the development of stroke in childhood. It is therefore recommend that blood pressure be measured and assessed carefully in every child presenting with acute stroke.

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Cerebral ischaemic stroke and bilateral pheochromocytoma

Cited by 11 publications

References 6 publications

Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

Von Hippel-Lindau Syndrome

Stroke and Hypertension in Children and Adolescents

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