Abstract

There are various reports on co-existence of neuroblastoma with congenital heart disease, however, the presence of congenital adrenal hyperplasia (CAH) is quite rare especially one presenting with hypertension and hence the need to look out for other anomalies and complications especially adrenocortical defects in patients with neuroblastoma. We report a case of a neonate who presented to our neonatal care unit with respiratory distress. On examination, he had abdominal distension, elevated blood pressure with presence of cardiac murmurs. A provisional diagnosis of Neuroblastoma to rule out congenital adrenal hyperplasia was made. He was admitted into the neonatal care unit and laboratory results showed high levels of urinary catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) with low cortisol level and high 11-deoxycortisol level. Abdominal ultrasound scan and chest computed tomography showed suprarenal mass and a posterior mediastinal mass respectively. Echocardiogram revealed a small ventricular septal defect (VSD) and a patent ductus arteriosus (PDA). He was reviewed by endocrinologist, cardiologist and oncologist. Blood pressure was controlled with anti-hypertensive with spontaneous closure of both VSD and PDA. Growth has remained steady with no complications on follow up. This is interesting because of the co-existence of neuroblastoma with congenital adrenal hyperplasia and congenital heart disease. We therefore recommend routine blood pressure monitoring in all neonates while patients with neuroblastoma may require further investigations and echocardiogram.