DEVELOPMENT OF HYPERTENSION IN NEUROBLASTOMA DURING THERAPY - A CASE-REPORT

A case of stage 4 neuroblastoma that developed excessive hypertension on day 120 of chemotherapy is presented. The tumor initially had respo nded well to chemotherapy; however, while the tumor mass decreased, pl asma and urine catecholamines and the blood pressure increased. The pl asma concentrations of noradrenaline, adrenaline, and dopamine increas ed to 26.4, 1.8, and 36.2 mug/l, respectively. The profile of catechol amine metabolites changed: on day 150 of therapy, noradrenaline, adren aline, and dopamine levels were increased, whereas HVA and VMA levels were decreased when compared to day 1 of therapy. The only residual ne uroblastoma tissue visible on MIBG scintigraphy on day 150 of treatmen t was a metastasis in the left tibia which was irradiated with 24 Gy. The adrenaline concentration in the left femoral vein was twice as hig h compared to the right femoral vein. A treatment, possibly radiation- associated tumor cell alteration resulting in a different catecholamin e production, is discussed. (C) 1993 Wiley-Liss, Inc.