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HTN in children (Aetiology (Endocrine
Adrenal: CAH, Cushings
Thyroid:…
HTN in children
Aetiology
Endocrine
Adrenal: CAH, Cushings
Thyroid: hyperthyroidism
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Neoplastic
CNS: phaeochromocytoma, neuroblastoma
Renal: Wilms, other tumours, PCKD
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Pathophysiology
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Endocrine disorders
Excess catecholamines, steroids, thyroxine etc.
E.g. phaeochromocytoma, neuroblastoma, CAH, Cushings, hyperthyroidism
Renal disorders
Reduced renal perfusion and
compensatory HTN via RAAS
Renal parenchymal disease COMMONEST
Diagnosis
Examination
Endocrine
Obesity, signs of endocrine disease,
virilisation (CAH)
Abdo exam
Obesity, any abdominal masses
Cardio exam
Asymmetrical pulses,
displaced apex
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Investigations
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Bloods
FBC (anaemia in renal disease), U+E (disturbed in
renal disease), LFT, TFTs (hyperthyroidism), lipids, glucose
Hormone profile (cortisol, adrenal)
Genetic screen (PCKD)
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History
FH
Renal disease, heart disease,
endocrine disorders
SH
Living arrangements, school/nursery,
social services involvement
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PC/HPC
Asymptomatic, headaches, facial weakness,
visual disturbances, seizures, vomiting,
palpitations, sweating
Management
Conservative
Information, advice, support
Lifestyle (weight loss, exercise, low salt)
Identify and manage cause
Monitoring (annual BP)
Medical
Anti-HTNs
Indication: symptomatic, comorbidities,
persistent despite lifestyle change
E.g. ACEi
Surgical
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Tumour resection
Indication: Wilm's, phaeochromocytoma
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Definition
SBP/DBP >95th centile for
gender, age and height
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Complications
HTN crisis
Presentation: cerebral oedema,
pulmonary oedema, HF, seizures
Management: IV labetalol, nifedipine,
Na nitroprusside