Feocromocitoma: uma causa rara de hipertensão arterial na infância Pheochromocytoma: a rare cause of hypertension in childhood

OBJETIVO: Relatar o caso de um adolescente com feocromocitoma, uma causa rara de hipertensão arterial na infância. DESCRIÇÃO: Adolescente internado em unidade de terapia intensiva infantil em decorrência de emergência hipertensiva, conseqüente à presença de feocromocitoma em adrenal esquerda, diagnosticado por meio de tomografia computadorizada do abdome e pela dosagem de adrenalina e noradrenalina urinárias. O paciente foi submetido à adrenalectomia esquerda, após o uso de alfa-bloqueador para controle do quadro hipertensivo. O anatomopatológico confirmou o diagnóstico do tumor. No pós-operatório, o paciente permaneceu estável, possibilitando a suspensão dos anti-hipertensivos. COMENTÁRIOS: Os feocromocitomas são tumores capazes de produzir catecolaminas, especialmente adrenalina e/ou noradrenalina. Cerca de 85 a 95% dos tumores são únicos, benignos e encontrados na medula adrenal. O feocromocitoma é um tumor de incidência rara e apenas 10 a 20% ocorrem na infância, representando uma causa rara de hipertensão arterial. Esta última é um sinal freqüente na maioria das crianças (80%), podendo ser acompanhada por cefaléia e sudorese. A encefalopatia hipertensiva consiste em uma forma de apresentação excepcional da doença. O diagnóstico pode ser realizado, na maioria dos casos, pela tomografia de abdome e pela dosagem das catecolaminas e seus metabólitos produzidos pelo tumor. O tratamento de escolha consiste na ressecção completa do tumor após o preparo farmacológico do paciente com o uso de alfa-bloqueador. No pós-operatório, a maioria dos pacientes evolui com controle do quadro de hipertensão arterial.<br>OBJECTIVE: Report an adolescent with pheochromocytoma, a rare cause of hypertension in childhood. CASE DESCRIPTION: Adolescent admitted to the pediatric intensive care unit due to hypertension, secondary to the presence of pheochromocytoma on the left adrenal. Diagnosis of the pheochromocytoma was made by abdominal computed tomography scan and by measuring urinary epinephrine and norepinephrine. The patient underwent excision of the left adrenal, after controlling blood pressure levels with an alpha-blocker drug. The histological analysis confirmed the diagnosis. After the surgery, the patient remained under control and the use of anti-hypertensive medication was stopped. COMMENTS: Pheochromocytomas are catecholamine-secreting tumors, specially epinephrine and norepinephrine. Almost 85 to 95% of the tumors are single, benign and found on adrenal medulla. Pheochromocytoma is a rare tumor - only 10 to 20% occur in childhood - and can cause hypertension. Hypertension is found in the majority of pediatric patients (80%), and may occur associated to headache and sweating. Hypertensive encephalopathy is very rare. The diagnosis can be done, in most cases, by computed tomography scans of the abdomen and by measuring levels of catecholamines and their metabolites produced by the tumor. The treatment of choice is the complete resection of the tumor after the use of an alpha-blocker medication. After the surgery, the majority of patients recover from hypertension

Genetic and linguistic correlation of the Kra-Dai-speaking groups in Thailand

The Kra-Dai linguistic family includes Thai and Lao as well as a great number of languages spoken by ethnic minorities in Southeast Asia. In Thailand, a dozen of other Kra-Dai languages are spoken in addition to Thai, the national language. The genetic structure of the Kra-Dai-speaking populations in Thailand has been studied extensively using uniparentally inherited markers. To extend this line of genetic investigation, this study used 15 autosomal microsatellites of 500 individuals from 11 populations, belonging to nine Kra-Dai ethnicities, namely, the Kaleung, Phu Thai, Saek, Nyo, Lao Isan, Yuan, Black Tai, Phuan and Lue. These ethnolinguistic groups are dispersed in three different geographic regions of Thailand, that is, Northern, Northeastern and Central. The results show a very low average of pairwised F(st) (0.0099), as well as no population substructure based on STRUCTURE analysis, indicating genetic homogeneity within the Kra-Dai-speaking group, possibly owing to shared linguistic ancestry. The Mantel test, an analysis of molecular variance, and the approximate Bayesian computation procedure employed to evaluate potential factors for driving genetic diversity revealed that language is the predominant factor affecting genetic variations, whereas geography is not. The result of distance-based clustering analyses and spatial analysis of molecular variance revealed genetic distinctions of some populations, reflecting the effects of genetic drift and gene flow on allele frequency within populations, in concordance with the result of R-matrix regression. The genetic and linguistic affiliations of the contemporary Kra-Dai-speaking groups are consistent with each other despite certain deviation due to various evolutionary factors that may have occurred during their migrations and resettlements