{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:53:27Z","timestamp":1791003207385,"version":"4.1.0"},"reference-count":7,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cyclic blood pressure fluctuations in pheochromocytoma are extremely rare, and previously reported cases have been limited to adults. We report a 5\u2010year\u2010old boy with von Hippel\u2013Lindau disease and a left adrenal pheochromocytoma who developed rapid cyclic blood pressure fluctuations immediately after tracheal intubation. Despite preoperative doxazosin (titrated from 0.5 to 3\u2009mg\/day over 27\u2009days) and fluid loading, systolic blood pressure oscillated between 50 and 150\u2009mmHg at approximately 7\u2010min intervals after tracheal intubation. The fluctuations were independent of surgical manipulation and refractory to phenylephrine and phentolamine. Plasma norepinephrine was markedly elevated before tumor manipulation. After tumor resection, profound vasoplegic hypotension required high\u2010dose norepinephrine, epinephrine, and vasopressin; hemodynamics gradually stabilized, and all vasoactive agents were discontinued on postoperative Day 3. This case demonstrates that pediatric pheochromocytoma can develop cyclic blood pressure fluctuations similar to those in adults and underscores the importance of individualized preoperative \u03b1\u2010blockade and strict postoperative hemodynamic management after tumor resection.<\/jats:p>","DOI":"10.1002\/ccr3.73583","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:18:59Z","timestamp":1791001139000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Pheochromocytoma With Rapid Cyclic Blood Pressure Fluctuations: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3587-2047","authenticated-orcid":false,"given":"Katsuaki","family":"Yamazaki","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Yodogawa Christian Hospital  Higashiyodogawa\u2010ku Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Pain Management and Palliative Care Medicine Kyoto Prefectural University of Medicine  Kamigyo\u2010ku Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Osaka City General Hospital  Miyakojima\u2010ku Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Osaka City General Hospital  Miyakojima\u2010ku Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"issue":"12","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1038\/s41574-024-01024-5","article-title":"International Consensus Statement on the Diagnosis and Management of Phaeochromocytoma and Paraganglioma in Children and Adolescents","volume":"20","author":"Casey R. T.","year":"2024","journal-title":"Nature Reviews. Endocrinology"},{"issue":"3","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1536\/ihj.29.389","article-title":"Periodic Fluctuation of Blood Pressure and Its Management in a Patient With Pheochromocytoma. Case Report and Review of the Literature","volume":"29","author":"Oishi S.","year":"1988","journal-title":"Japanese Heart Journal"},{"issue":"1","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1038\/ncpcardio1054","article-title":"Pheochromocytoma: Cyclic Attacks of Hypertension Alternating With Hypotension","volume":"5","author":"Kobal S. L.","year":"2008","journal-title":"Nature Clinical Practice. Cardiovascular Medicine"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/4073536","article-title":"Extreme and Cyclical Blood Pressure Elevation in a Pheochromocytoma Hypertensive Crisis","volume":"2018","author":"Larouche V.","year":"2018","journal-title":"Case Reports in Endocrinology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1530\/EDM-20-0115","article-title":"Pheochromocytoma Crisis With Cyclic Fluctuation in Blood Pressure Mimics Acute Coronary Syndrome","volume":"2020","author":"Kometani M.","year":"2020","journal-title":"Endocrinology, Diabetes & Metabolism Case Reports"},{"issue":"1","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","DOI":"10.1186\/s40981-022-00569-6","article-title":"Rapid Cyclic Fluctuations in Blood Pressure During Two Surgeries Associated With Pheochromocytoma: A Case Report","volume":"8","author":"Watanabe T.","year":"2022","journal-title":"JA Clinical Reports"},{"issue":"11","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1053\/j.jvca.2024.07.026","article-title":"Cardiac Arrest in a Patient Unveils Pheochromocytoma With Rare Clinical Manifestation Requiring Extracorporeal Membrane Oxygenation and Urgent Surgery","volume":"38","author":"Edgren H.","year":"2024","journal-title":"Journal of Cardiothoracic and Vascular Anesthesia"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73583","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73583","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73583","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:19:01Z","timestamp":1791001141000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":7,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/ccr3.73583"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73583","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73583"}}