Hypertension in an Adolescent Athlete
A healthy, 16-year-old, African American, male basketball player had blood pressure (BP) readings of 180-190/90-100 mm Hg during a preseason sports physical examination. On follow-up a few days later, his BP was 220/118 mm Hg. He was sent to the emergency room where his BP was 196/80 mm Hg. His physical examination was otherwise normal. He was admitted for further evaluation and management. Acutely, his BP was reduced with nifedipine. Repeat measurements showed a gradient of 25 mm Hg between right upper and lower extremities. Serum electrolytes, urine analysis, and renal ultrasound were normal. A duplex ultrasound revealed a change in aortic caliber below the origin of the superior mesenteric artery. A focused cardiology examination after admission revealed an abdominal bruit and slightly decreased femoral pulses. A computed tomography angiogram (CTA) showed a 5.1 cm segment of narrowing in the abdominal aorta, with narrowest luminal diameter of 0.5 cm, extending from the origin of the superior mesenteric artery to the origin of the inferior mesenteric artery and involving bilateral renal arteries and the proximal celiac artery (Figure 1). An echocardiogram showed moderate to severe concentric left ventricular hypertrophy (LVH) with normal biventricular systolic function. A dilated ophthalmic exam was normal. Thyroid stimulating hormone, erythrocyte sedimentation rate, and renin activity were normal. A magnetic resonance angiogram revealed normal carotid arteries.
Midaortic syndrome (MAS)
Hospital Course and Follow-up
The patient was treated with transdermal clonidine and long-acting oral nifedipine. He underwent percutaneous bilateral renal artery angioplasties and was placed on aspirin. His BP remained controlled for 2 weeks on antihypertensive medications. However, 1 month later, his BP was 160-180/80-90 mm Hg due to restenosis. Abdominal aorta and bilateral renal artery stenting was performed percutaneously. After the second procedure, …
Autor / Fonte:Carolyn M Kienstra, Albert C Hergenroeder, Alyssa A Riley, Henri Justino Clinical Pediatrics 2015 November 3