NEW YORK (Reuters Health) - Pheochromocytomas and paragangliomas (PHEO/PGLs) may cause the same symptoms as attention deficit hyperactivity disorder (ADHD) in children, leading to inappropriate treatment that could worsen the children's symptoms and potentially endanger their health, researchers from the U.S. National Institutes of Health report.
"Pheochromocytomas and paragangliomas are rare catecholamine-secreting tumors that arise from chromaffin cells of the sympathetic nervous system (adrenal medulla and sympathetic chain). Release of catecholamines into the circulation by these tumors causes significant hypertension, and catecholamines also are known to stimulate the central nervous system, as well," explained lead study author Dr. Maya Lodish of the National Institute of Child Health and Human Development (NICHD).
Such tumors are "extremely rare, and the vast majority of children with ADHD are unaffected by them," Dr. Lodish told Reuters Health by email. "However, they do occur (and) may cause symptoms that mimic ADHD in children, including inattention and anxiety. If these tumors are missed and children are inappropriately treated with medications designed to treat ADHD, their symptoms of tachycardia and hypertension could worsen."
The NIH team investigated the association between ADHD and PHEO/PGL by assessing 43 children with PHEO/PGL. They found that nine of the children had been diagnosed with ADHD before their tumors had been discovered. Of those, four had been treated with stimulant drugs typically prescribed for ADHD (amphetamine, dextroamphetamine or methylphenidate), which caused some to develop headaches, excessive sweating, and hypertension, the team reports in Hormone and Metabolic Research, online May 12.
In addition, the researchers found that four patients were hypertensive when first diagnosed with PHEO/PGL. And, in three patients, ADHD symptoms resolved after successful surgical removal of the tumors.
"Our study found a prevalence of ADHD in 21% of our PHEO/PGL patients, significantly higher than the 7.2 % seen in the general pediatric population," the authors observe. "Anxiety and difficulty in concentration in these patients may have been related to their underlying PHEO/PGL and were not recognized as part of the constellation of symptoms."
Dr. Lodish adds, "This is a report of our preliminary findings in a cohort of children with a rare disease; it is by no means meant to scare families of children with ADHD that their child might have a rare tumor. ADHD is being diagnosed more frequently in children, and the use of medications to treat ADHD is also on the rise. However, ADHD is a diagnosis of exclusion that cannot be attributed to an underlying disorder."
"As recommended by the American Academy of Pediatrics, physicians should carefully assess children being considered for ADHD therapy prior to initiating medical therapy," she says. "Children with a family history of endocrine tumors and children with high blood pressure on screening should undergo a thorough evaluation for organic causes of hypertension prior to initiating stimulant therapy."
Commenting on the findings, Dr. Angela Lennon, a pediatric endocrinologist at the University of Kansas Hospital in Kansas City, told Reuters Health by email, "This is a very interesting study relating a very common condition, ADHD, and a rare but life-threatening condition, PHEO/PGL."
Echoing the authors, she notes that "inattention, anxiety and hyperactivity are not well-known features of these catecholamine-secreting tumors, but in the setting of hypertension, (PHEO/PGL) should be ruled out (by) obtaining catecholamine levels in the blood or urine."
The study was funded by the NICHD. The authors declare no conflicts of interest.
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