視力低下を契機に発見された小児褐色細胞腫の1例

Visual impairment as the initial manifestation of pheochromocytoma in a child

　8歳女児が視力低下と頭痛で受診した。矯正視力は左右とも0.1であった。両眼眼底に出血，軟性白斑，黄斑浮腫，乳頭の発赤・腫脹があった。高血圧眼底であり，血圧は165／115mmHgであった。画像検査で右腎に腫瘤があり，尿中バニリルマンデル酸と血中ノルアドレナリンが高く，臨床的に褐色細胞腫と診断した。副腎を含む腫瘍摘出術後に血圧は正常化し，視力はほとんど正常化し，眼底所見も軽快した。摘出腫瘍の病理組織診断は褐色細胞腫に一致した。小児に高血圧眼底がある場合には，腎性高血圧だけでなく，内分泌性高血圧がその原因になり得ることを示す症例である。

An 8-year-old girl presented with headache and bilateral visual impairment. Her corrected vis-ual acuity was 0.1 in either eye. Funduscopy showed hypertensive change including hemorrhage, soft exu-dates, macular edema and swelling of optic disc in both eyes. Her blood pressure was 165/115mmHg. Labora-tory studies showed elevated values of urine vanillylmandelic acid and serum noradrenalin. Computerized tomography (CT) and magnetic resonance imaging (MRI) showed a tumor superior to the right kidney. These findings led to the diagnosis of pheochromocytoma. Excision of the tumor was followed by normalization of blood pressure, fundus findings, and visual acuity. Pathological diagnosis was the same as the clinical one.This case illustrates that pheochromocytoma may be the underlying cause of hypertensive retinopathy in a child.