Abstract
Primary hypertension among children is now more common than hypertension due to secondary causes. As a result, broad screens for secondary causes are no longer recommended in most children, and a limited initial evaluation is preferred. In young children and those with severe hypertension, the pretest probability of secondary hypertension increases and a more detailed evaluation is required. The array of diagnostic tests available for this purpose continues to evolve. This chapter explains the rationale behind these recommended tests and discusses the evidence-base about their accuracy, where available.
References
Albert TS, Akahane M, Parienty I et al (2015) An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial. Am J Roentgenol 204:182–188
Arafat M, Mattoo TK (1999) Measurement of blood pressure in children: recommendations and perceptions on cuff selection. Pediatrics 104:e30
Barontini M, Levin G, Sanso G (2006) Characteristics of pheochromocytoma in a 4- to 20-year-old population. Ann N Y Acad Sci 1073:30–37
Bausch B, Wellner U, Bausch D et al (2014) Long-term prognosis of patients with pediatric pheochromocytoma. Endocr Relat Cancer 21(1):17–25
Berends AMA, Buitenwerf E, de Krijger RR et al (2018) Incidence of pheochromocytoma and sympathetic paraganglioma in the Netherlands: a nationwide study and systematic review. Eur J Intern Med 51:68–73
Bombardieri E, Giammarile F, Aktolun C et al (2010) 131I/123I-metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 37:2436–2446
Bondanelli M, Ambrosio MR, degli Uberti EC (2001) Pathogenesis and prevalence of hypertension in acromegaly. Pituitary 4:239–249
Bouhanick B, Fauvel J, Pont F (2010) Biochemical misdiagnosis of pheochromocytoma in patients treated with sulfasalazine. JAMA 304:1898–1901
Boyden LM, Choi M, Choate KA et al (2012) Mutations in kelch-like 3 and cullin 3 cause hypertension and electrolyte abnormalities. Nature 482:98–102
Brady TM, Stefani-Glucksberg A, Simonetti GD (2019) Management of high blood pressure in children: similarities and differences between US and European guidelines. Pediatr Nephrol 34:405–412
Chen H, Sippel RS, O’Dorisio MS et al (2010) The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 39:775–783
Chen Y, Xiao H, Zhou X et al (2017) Accuracy of plasma free metanephrines in the diagnosis of pheochromocytoma and paraganglioma: a systematic review and meta-analysis. Endocr Pract 23:1169–1177
Chhadia S, Cohn RA, Vural G, Donaldson JS (2013) Renal Doppler evaluation in the child with hypertension: a reasonable screening discriminator? Pediatr Radiol 43:1549–1556
Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC (1989) Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 80(4):840–845
Crossland DS, Furness JC, Abu-Harb M, Sadagopan SN, Wren C (2004) Variability of four limb blood pressure in normal neonates. Archives of disease in childhood Fetal and neonatal edition 89(4):F325–327
Cui Y, Tong A, Jiang J, Wang F, Li C (2017) Liddle syndrome: clinical and genetic profiles. J Clin Hypertens 19:524–529
Darr R, Kuhn M, Bode C et al (2017) Accuracy of recommended sampling and assay methods for the determination of plasma-free and urinary fractionated metanephrines in the diagnosis of pheochromocytoma and paraganglioma: a systematic review. Endocrine 56:495–503
Davidson FD (2004) Paracetamol-associated interference in an HPLC-ECD assay for urinary free metadrenalines and catecholamines. Ann Clin Biochem 41:316–320
de Jong WH, Eisenhofer G, Post WJ, Muskiet FA, de Vries EG, Kema IP (2009) Dietary influences on plasma and urinary metanephrines: implications for diagnosis of catecholamine-producing tumors. J Clin Endocrinol Metab 94:2841–2849
Deal JE, Snell MF, Barratt TM, Dillon MJ (1992) Renovascular disease in childhood. J Pediatr 121:378–384
DelRosso LM, King J, Ferri R (2018) Systolic blood pressure elevation in children with obstructive sleep apnea is improved with positive airway pressure use. J Pediatr 195:102–107.e101
Deutschbein T, Unger N, Jaeger A et al (2010) Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma. Clin Endocrinol 73:153–160
Dillon MJ, Shah V, Barratt TM (1978) Renal vein renin measurements in children with hypertension. Br Med J 2:168–170
Duncombe SL, Voss C, Harris KC (2017) Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens 35:213–224
Eisenhofer G, Peitzsch M (2014) Laboratory evaluation of pheochromocytoma and paraganglioma. Clin Chem 60:1486–1499
Eisenhofer G, Goldstein DS, Walther MM et al (2003) Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab 88:2656–2666
Eleftheriou D, Dillon MJ, Tullus K et al (2013) Systemic polyarteritis nodosa in the young: a single-center experience over thirty-two years. Arthritis Rheum 65:2476–2485
Flynn J (2013) The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol 28:1059–1066
Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966
Flynn J, Zhang Y, Solar-Yohay S, Shi V (2012) Clinical and demographic characteristics of children with hypertension. Hypertension 60:1047–1054
Flynn JT, Daniels SR, Hayman LL et al (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–1135
Flynn JT, Kaelber DC, Baker-Smith CM et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904
Fommei E, Iervasi G (2002) The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab 87:1996–2000
Fugate JE, Rabinstein AA (2015) Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 14:914–925
Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA (2010) Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 85:427–432
Gordon R (1986) Syndrome of hypertension and hyperkalemia with normal glomerular filtration rate. Hypertension 8:93–102
Guemes M, Murray PG, Brain CE et al (2016) Management of Cushing syndrome in children and adolescents: experience of a single tertiary centre. Eur J Pediatr 175:967–976
Guignat L, Bertherat J (2010) The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective. Eur J Endocrinol 163:9–13
Hellstrom A, Hanson E, Hansson S, Hjalmas K, Jodal U (1991) Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child 166:232–234
Inukai T, Hirose K, Inaba T et al (2007) Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19. Leukemia 21:288–296
Ittermann T, Thamm M, Wallaschofski H, Rettig R, Volzke H (2012) Serum thyroid-stimulating hormone levels are associated with blood pressure in children and adolescents. J Clin Endocrinol Metab 97:828–834
Kang KT, Chiu SN, Lin CY, Weng WC, Lee PL, Hsu WC (2019) Effect of adenotonsillectomy on ambulatory blood pressure in pediatric obstructive sleep apnea: 6-month follow-up study. Otolaryngol Head Neck Surg 160:911–921
Karas M, Lacourcière Y, LeBlanc AR et al (2005) Effect of the renin–angiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients. J Hypertens 23:1251–1260
Klein I, Ojamaa K (2001) Thyroid hormone and the cardiovascular system. N Engl J Med 344:501–509
Kline G, Boyd J, Leung A, Tang A, Sadrzadeh H (2020) Very high rate of false positive biochemical results when screening for pheochromocytoma in a large, undifferentiated population with variable indications for testing. Clin Biochem 77:26–31
Komur M, Ozgur A, Delibas A et al (2020) Posterior reversible encephalopathy syndrome (PRES) due to acute hypertension in children: 12 years single-center experience. Acta Neurol Belg. https://doi.org/10.1007/s13760-020-01423-1
Kraft JK, Brandao LR, Navarro OM (2011) Sonography of renal venous thrombosis in neonates and infants: can we predict outcome? Pediatr Radiol 41:299–307
Kuhle S, Massicotte P, Chan A, Mitchell L (2004) A case series of 72 neonates with renal vein thrombosis. Data from the 1-800-NO-CLOTS registry. Thromb Haemost 92:729–733
Larkins NG, Teixeira-Pinto A, Craig JC (2019) A narrative review of proteinuria and albuminuria as clinical biomarkers in children. J Paediatr Child Health 55:136–142
Lee SG, Ryu JS, Kim HO, Oh JS, Kim YG, Lee CK, Yoo B (2009) Evaluation of disease activity using F-18 FDG PET-CT in patients with Takayasu arteritis. Clin Nucl Med 34:749–752
Lenders J, Eisenhofer G, Armando I et al (1993) Determination of metanephrines in plasma by liquid chromatography with electrochemical detection. Clin Chem 39:97–103
Lenders JW, Pacak K, Walther MM et al (2002) Biochemical diagnosis of pheochromocytoma: which test is best? JAMA 287:1427–1434
Lenders JWM, Eisenhofer G, Mannelli M, Pacak K (2005) Phaeochromocytoma. Lancet 366:665–675
Lenders JW, Willemsen JJ, Eisenhofer G et al (2007) Is supine rest necessary before blood sampling for plasma metanephrines? Clin Chem 53:352–354
Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al (2014) Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(6):1915–1942
Lodish MB, Sinaii N, Patronas N et al (2009) Blood pressure in pediatric patients with Cushing syndrome. J Clin Endocrinol Metab 94:2002–2008
Lumachi F, Tregnaghi A, Zucchetta P et al (2006) Sensitivity and positive predictive value of CT, MRI and 123I-MIBG scintigraphy in localizing pheochromocytomas: a prospective study. Nucl Med Commun 27:583–587
Lurbe E, Agabiti-Rosei E, Cruickshank JK (2016) European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920
Maass PG, Aydin A, Luft FC et al (2015) PDE3A mutations cause autosomal dominant hypertension with brachydactyly. Nat Genet 47:647–653
Marks SD, Massicotte MP, Steele BT et al (2005) Neonatal renal venous thrombosis: clinical outcomes and prevalence of prothrombotic disorders. J Pediatr 146:811–816
McCulloch M, Andronikou S, Goddard E et al (2003) Angiographic features of 26 children with Takayasu’s arteritis. Pediatr Radiol 33:230–235
McTaggart SJ, Gulati S, Walker RG, Powell HR, Jones CL (2000) Evaluation and long-term outcome of pediatric renovascular hypertension. Pediatr Nephrol 14:1022–1029
Morineau G, Sulmont V, Salomon R et al (2016) Apparent mineralocorticoid excess: report of six new cases and extensive personal experience. J Am Soc Nephrol 17:3176–3184
Neumann HPH, Young WF Jr, Eng C (2019) Pheochromocytoma and paraganglioma. N Engl J Med 381:552–565
Nevin SM, McLoone J, Wakefield CE, Kennedy SE, McCarthy HJ (2020) Genetic testing in the pediatric nephrology clinic: understanding families’ experiences. J Pediatr Genet. https://doi.org/10.1055/s-0040-1721439
Nieman LK, Biller BM, Findling JW et al (2008) The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 93:1526–1540
O’Sullivan JJ, Derrick G, Darnell R (2002) Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart 88:163–166
Olson SW, Yoon S, Baker T et al (2016) Longitudinal plasma metanephrines preceding pheochromocytoma diagnosis: a retrospective case-control serum repository study. Eur J Endocrinol 174:289–295
Orman G, Masand PM, Kukreja KU, Acosta AA, Guillerman RP, Jadhav SP (2021) Diagnostic sensitivity and specificity of CT angiography for renal artery stenosis in children. Pediatr Radiol 51:419–426
Peitzsch M, Mangelis A, Eisenhofer G, Huebner A (2019) Age-specific pediatric reference intervals for plasma free normetanephrine, metanephrine, 3-methoxytyramine and 3-O-methyldopa: particular importance for early infancy. Clin Chim Acta 494:100–105
Peitzsch M, Kaden D, Pamporaki C et al (2020) Overnight/first-morning urine free metanephrines and methoxytyramine for diagnosis of pheochromocytoma and paraganglioma: is this an option? Eur J Endocrinol 182:499–509
Qi WX, He AN, Shen Z, Yao Y (2013) Incidence and risk of hypertension with a novel multi-targeted kinase inhibitor axitinib in cancer patients: a systematic review and meta-analysis. Br J Clin Pharmacol 76:348–357
Raza J, Hindmarsh PC, Brook CGD (2007) Thyrotoxicosis in children: thirty years’ experience. Acta Paediatrica 88(9):937–941
Rich GM, Ulick S, Cook S, Wang JZ, Lifton RP, Dluhy RG (1992) Glucocorticoid-remediable aldosteronism in a large kindred: clinical spectrum and diagnosis using a characteristic biochemical phenotype. Ann Intern Med 116:813–820
Rogoff D, Bergada I, Venara M, Chemes H, Heinrich JJ, Barontini M (2001) Intermittent hyperaldosteronism in a child due to an adrenal adenoma. Eur J Pediatr 160:114–116
Rumman RK, Matsuda-Abedini M, Langlois V et al (2018) Management and outcomes of childhood renal artery stenosis and middle aortic syndrome. Am J Hypertens 31:687–695
Russo RAG, Katsicas MM (2018) Takayasu arteritis. Front Pediatr 6:265
Saida K, Kamei K, Hamada R et al (2020) A simple, refined approach to diagnosing renovascular hypertension in children: a 10-year study. Pediatr Int 62:937–943
Sanders AP, Mazzella MJ, Malin AJ et al (2019) Combined exposure to lead, cadmium, mercury, and arsenic and kidney health in adolescents age 12-19 in NHANES 2009-2014. Environ Int 131:104993
Sarma A, Grant F, Johnston P et al (2017) The yield of DMSA renal cortical scintigraphy in pediatric patients with hypertension. J Nucl Med 58:526–526
Shaikh N, Craig JC, Rovers MM, Da Dalt L, Gardikis S, Hoberman A, Montini G, Rodrigo C, Taskinen S, Tuerlinckx D, Shope T (2014) Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatr 168:893–900
Shroff R, Roebuck DJ, Gordon I et al (2006) Angioplasty for renovascular hypertension in children: 20-year experience. Pediatrics 118:268–275
Siebert E, Spors B, Bohner G, Endres M, Liman TG (2013) Posterior reversible encephalopathy syndrome in children: radiological and clinical findings – a retrospective analysis of a German tertiary care center. Eur J Paediatr Neurol 17:169–175
Singh HP, Hurley RM, Myers TF (1992) Neonatal hypertension: incidence and risk factors. Am J Hypertens 5:51–55
Soliman M, Laxer R, Manson D, Yeung R, Doria AS (2015) Imaging of systemic vasculitis in childhood. Pediatr Radiol 45:1110–1125
Song P, Zhang Y, Yu J et al (2019) Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr 173:1–10
Sox HC (2004) Commentary: accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann Intern Med 141:682
Stanley JC, Criado E, Upchurch GR Jr et al (2006) Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children. J Vasc Surg 44(6):1219–1228; discussion 1228–1219
Taieb D, Hicks RJ, Hindie E et al (2019) European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 46:2112–2137
Tomita T, Poisner A, Inagami T (1987) Immunohistochemical localization of renin in renal tumors. Am J Pathol 126:73–80
Torres AD, Rai AN, Hardiek ML (2000) Mercury intoxication and arterial hypertension: report of two patients and review of the literature. Pediatrics 105:e34
Trasande L, Sathyanarayana S, Spanier AJ, Trachtman H, Attina TM, Urbina EM (2013) Urinary phthalates are associated with higher blood pressure in childhood. J Pediatr 163:747–753. e741
Trautmann A, Roebuck DJ, McLaren CA, Brennan E, Marks SD, Tullus K (2016) Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension. Pediatr Nephrol 32:495–502
Trehan A, Cheetham T, Bailey S (2009) Hypercalcemia in acute lymphoblastic leukemia: an overview. J Pediatr Hematol Oncol 31:424–427
Trnka P, Orellana L, Walsh M, Pool L, Borzi P (2014) Reninoma: an uncommon cause of renin-mediated hypertension. Front Pediatr 2:89
Tullus K (2013) Renovascular hypertension – is it fibromuscular dysplasia or Takayasu arteritis. Pediatr Nephrol 28:191–196
Tullus K (2015) Outcome of post-infectious renal scarring. Pediatr Nephrol 30:1375–1377
Tullus K, Brennan E, Hamilton G et al (2008) Renovascular hypertension in children. Lancet 371:1453–1463
Tyagi S, Kaul UA, Satsangi DK, Arora R (1997) Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics 99:44–49
van Stijn D, Planken N, Kuipers I, Kuijpers T (2021) CT angiography or cardiac MRI for detection of coronary artery aneurysms in Kawasaki disease. Front Pediatr 9:630462
Vasbinder G, Nelemans P, Kessels A et al (2004) Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann Intern Med 141:674–682
Versmissen J, Mirabito Colafella KM, Koolen SLW, Danser AHJ (2019) Vascular cardio-oncology: vascular endothelial growth factor inhibitors and hypertension. Cardiovasc Res 115:904–914
Viering D, Chan MMY, Hoogenboom L et al (2020) Genetics of renovascular hypertension in children. J Hypertens 38:1964–1970
Vo NJ, Hammelman BD, Racadio JM, Strife CF, Johnson ND, Racadio JM (2006) Anatomic distribution of renal artery stenosis in children: implications for imaging. Pediatr Radiol 36:1032–1036
Warejko JK, Schueler M, Vivante A et al (2018) Whole exome sequencing reveals a monogenic cause of disease in approximately 43% of 35 families with Midaortic syndrome. Hypertension 71:691–699
Warren HR, Evangelou E, Cabrera CP et al (2017) Genome-wide association analysis identifies novel blood pressure loci and offers biological insights into cardiovascular risk. Nat Genet 49:403–415
Weise M, Merke DP, Pacak K, Walther MM, Eisenhofer G (2002) Utility of plasma free metanephrines for detecting childhood pheochromocytoma. J Clin Endocrinol Metab 87:1955–1960
Winyard PJ, Bharucha T, De Bruyn R et al (2006) Perinatal renal venous thrombosis: presenting renal length predicts outcome. Arch Dis Childh Fetal Neonatal Ed 91:F273–F278
Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590
Wyszyńska T, Cichocka E, Wieteska-Klimczak A, Jobs K, Januszewicz P (1992) A single pediatric center experience with 1025 children with hypertension. Acta Paediatr 81:244–246
Yokomori K, Hori T, Takemura T, Tsuchida Y (1988) Demonstration of both primary and secondary reninism in renal tumors in children. J Pediatr Surg 23:403–409
Zinner SH, Levy PS, Kass EH (1971) Familial aggregation of blood pressure in childhood. N Engl J Med 284:401–404
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Larkins, N., Roebuck, D. (2022). Diagnostic Evaluation of Pediatric Hypertension. In: Flynn, J.T., Ingelfinger, J.R., Brady, T. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31420-4_32-2
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Diagnostic Evaluation of Pediatric Hypertension- Published:
- 24 May 2022
DOI: https://doi.org/10.1007/978-3-319-31420-4_32-2
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Diagnostic Evaluation of Pediatric Hypertension- Published:
- 21 April 2017
DOI: https://doi.org/10.1007/978-3-319-31420-4_32-1