Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case

Abstract

A 13-year-old was admitted to our clinic complaining about a vision loss of over 2 weeks. Bilateral optic disc edema, peripapillary flame-shaped hemorrhages, macular star pattern exudates, and cotton wool spots were found in fundoscopic examination. The OCT exam showed bilaterally serous retinal detachments in sub-foveal region with intraretinal exudates. A pediatric examination found a high systemic hypertension of 230/140 mm Hg, and laboratory tests revealed increased levels of plasmatic and urinary catecholamines. An abdominal MRI showed a left suprarenal pheochromocytoma and the child underwent an adrenalectomy urgently. Informed patient consent was obtained from legal guardians to publish clinical images. Malignant hypertension (MHT) as a result of a pheochromocytoma is an extremely rare condition in childhood. MHT crisis represents a potential life-threatening event and an immediate treatment can prevent a multi-organ failure, including the eyes. An early diagnosis of MHT by fundus examination can lead to a completely favorable ophthalmological evolution and entirely functional recovery.