Development of hypertension in neuroblastoma during therapy: A case report

Abstract

A case of stage 4 neuroblastoma that developed excessive hypertension on day 120 of chemotherapy is presented. The tumor initially had responded well to chemotherapy; however, while the tumor mass decreased, plasma and urine catecholamines and the blood pressure increased. The plasma concentrations of noradrenaline, adrenaline, and dopamine increased to 26.4, 1.8, and 36.2 micrograms/l, respectively. The profile of catecholamine metabolites changed: on day 150 of therapy, noradrenaline, adrenaline, and dopamine levels were increased, whereas HVA and VMA levels were decreased when compared to day 1 of therapy. The only residual neuroblastoma tissue visible on MIBG scintigraphy on day 150 of treatment was a metastasis in the left tibia which was irradiated with 24 Gy. The adrenaline concentration in the left femoral vein was twice as high compared to the right femoral vein. A treatment, possibly radiation-associated tumor cell alteration resulting in a different catecholamine production, is discussed.

Variants of Cardiomyopathy and Hypertension in Neuroblastoma

“…This phenomenon has been reported before. 4 Any stress is able to incite a paroxysmal attack and amine release could occur after chemotherapy. The triggering mechanism is unknown.…”

Cyclic fluctuation of blood pressure in neonatal neuroblastoma

“…Catecholamine excess can induce several other complications, such as hypertension, seizure, heart failure, cardiomegaly, and symptoms mimicking early‐onset sepsis in patients with neuroblastoma. These catecholamine‐induced symptoms are usually observed on admission, but sudden hypertension and lung edema caused by the induction of anesthesia, exacerbation of hypertension on the day following the first dose of chemotherapy, and hypertension that developed >100 days after the initiation of chemotherapy have also been reported . Irradiation to a tibial metastasis was presumed to be the cause of persistent catecholamine overproduction in the last case.…”

Perioperative management of a child with severe hypertension from a catecholamine secreting neuroblastoma

“…blood pressure management and a further increase of the patient's doses of oral phenoxybenzamine and enalapril. These episodes were interpreted as tumor lysis with release of additional catecholamines (5). The lack of a hypertensive episode during the last two preoperative cycles of chemotherapy could indicate progress in tumor reduction.…”