Recurrencia de feocromocitoma en escolar de 11 años diagnosticado por I-131 MIBG / Recurrence of pheocromocytoma in 11 years old school child, diagnosed by I-131 MIBG

Pheocromocytoma is a paraganglioma with an incidence of arterial hypertension approximately of 1 percent ,but its diagnosis has several important issues from the clinical point of view. 1-The tumor resection frecuently cure the hypertension. 2.-Its manifestations might simulates other diseases like carcinoid Sx, hypertiroidism,etc. 3.-It is a familiar disease transmitted by an autosomic dominant way. It is 10 percent ilateral, 10 percent extraadrenal, 10 percent occur in children and 10 percent are malignant. We present a case of pheocromocytoma recurrency in a young girl,11 y.o. operated 8 months before, at the Clinical Hospital, National University of Paraguay, School of Medicine for a right suprarrenal gland pheocromocytoma of 2cms of diameter, who consults the Pediatryc Department for arterial hypertension and cefalea. She also had a Von Hippel Sx and Glaucoma. Nuclear Medicine is a non invasive method that use the I-131M ethayodobencylguanidine(MIBG-I-131) with high accuracy to diagnose and treat both neuroblastoma and pheocromocytoma I-131 MIBG is the gold standard for the diagnosis of both entities with a sensitivity between 94-100 percent and specificity of 100 percent being the best method to evaluate these diseases in the pre and post operatory

Thalidomide, a current teratogen in South America.

Thalidomide, mainly used for the treatment of leprosy, is a current teratogen in South America, and it is reasonable to assume that at present this situation is affecting many births in underdeveloped countries. Moreover, the potential re-marketing of thalidomide for the treatment of a large variety of diseases may extend the problem to the developed world. When the drug is available, the control of its intake during early pregnancy is very difficult since most pregnancies are unintended. The ongoing occurrence of thalidomide embryopathy cases went undetected by the ECLAMC, due to several factors: (1) low populational coverage through this monitoring system; (2) pre-existence of the teratogen with its effects present in both baseline (expected) and monitored (observed) materials; and (3) lack of a defined phenotype to be monitored. Thus, if thalidomide re-enters the market throughout the world, due to the wide range of new applications, occurrence of phocomelia alone might not be sufficient to detect its effects. By a case-reference approach, the ECLAMC registered 34 thalidomide embryopathy cases born in South America after 1965 whose birthplaces correspond to endemic areas for leprosy. Phocomelia was found in five of eleven fully described cases. Thus, phocomelia alone is neither specific nor sufficient to serve as a suitable phenotype to survey the teratogenic effects of thalidomide. Therefore, a thalidomide-like phenotype, defined as any bilateral upper and/or lower limb reduction defect of the preaxial and/or phocomelia types, should be included in the routine surveillance of birth defects in all programmes.