Severe hypertension and cardiac failure associated with neuroblastoma: A case report

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

“…Few studies have focused on the perioperative management of HT, and most of these have been case reports [1][2][3][4][5][6][7][8][9]. Both cardiac and neurological complications of HT have been described [10].…”

“…Although the secretion of catecholamines may be increased in NB patients, HT and other symptoms of catecholamine excess frequently observed in pheochromocytoma have been reported in relatively few children with NB (1)(2)(3)(4)(5)(6)(7)(8)(9). This difference is probably owing to the presence of many storage granules in pheochromocytoma, which release large quantities of catecholamines, thereby causing HT.…”

“…Preoperative echocardiography is the cornerstone in the diagnostic workup of these patients, as catecholamine excess can induce several complications other than, or subsequent to, HT, including seizures and heart failure, cardiomyopathy, cardiomegaly and cardiogenic shock [3,6,15,[17][18][19][20][21][22][23][24][25][26]. All in all, preoperative HT control has lowered reported mortality from 13% to 45% to 0%-3% in patients with catecholaminesecreting tumors [27].…”

“…Whatever the cause of HT in NB, symptoms are generally well controlled by the preoperative administration of alpha-1 adrenergic blocking agents, such as phenoxybenzamine, phentolamine, prazosin and, more recently, doxazosin [3,4,6,9,[17][18][19][20][21][22][23][24][25][26].…”

“…Therefore, the availability of a wide range of rapidly acting medications to treat intraoperative hypertensive peaks is mandatory; these include prostaglandin E1, diuretics, calcium channel antagonists, sodium nitroprusside, hydralazine, magnesium sulfate, phentolamine, adenosine, and fenoldopam [4,6,[20][21][22]. Beta blockers, such as propranolol, labetalol, atenolol and esmolol, may be administered intraoperatively in association with alpha-1 blockers to control catecholamineinduced arrhythmia and tachycardia [4,6].…”