Indian Pediatrics

, Volume 56, Issue 1, pp 69–71 | Cite as

Hyponatremic-Hypertensive Syndrome in Ovarian Paraganglioma

  • Manish KumarEmail author
  • Aashima Dabas
  • Vivek Manchanda
  • Nidhi Mahajan
  • Kaustuv Mitra
Case Report



Hyponatremic-hypertensive syndrome (HHS) is characterized by combination of polyuria, polydipsia, hypertension, hyponatremia and hypokalemia in association with unilateral renal artery stenosis.

Case characteristics

A 10-year-old girl presented with polyuria, polydipsia, hypertension, hyponatremia, hypokalemia and proteinuria. Ultrasonography with doppler study revealed bilateral normal renal arteries. Completed tomography of abdomen detected a left adnexal mass, which was later confirmed as ovarian paraganglioma on histopathology.


After tumor excision, polyuria subsided and blood pressure normalized.


Hyponatremic-Hypertensive Syndrome does not always result from unilateral renal artery stenosis. High index of clinical suspicion with appropriate imaging technique may clinch rare endocrine causes of hypertension, like paraganglioma.


Hypertension Nocturnal enuresis Paraneoplastic syndrome Polyuria 


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  1. 1.
    Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, et al. Renovascular hypertension in children. Lancet. 2008;371:1453–63.CrossRefGoogle Scholar
  2. 2.
    Pandey M, Sharma R, Kanwal SK, Chhapola V, Awasthy N, Mathur A, et al. Hyponatremic-hypertensive syndrome: Think of unilateral renal artery stenosis. Indian J Pediatr. 2013; 80:872–4.CrossRefGoogle Scholar
  3. 3.
    Mukherjee D, Sinha R, Akhtar MS, Saha AS. Hyponatremic hypertensive syndrome-a retrospective cohort study. World J Nephrol. 2017;6:41–44.CrossRefGoogle Scholar
  4. 4.
    Kovalski Y, Cleper R, Krause I, Dekel B, Belenky A, Davidovits M. Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare? Pediatr Nephrol. 2012;27:1037–40.CrossRefGoogle Scholar
  5. 5.
    Bholah R, Bunchman TE. Review of pediatric pheochromocytoma and paraganglioma. Front Pediatr. 2017; 5:155.CrossRefGoogle Scholar
  6. 6.
    Kefell M, Usubütün A. An update of neuroendocrine tumors of the female reproductive system. Turk J Pathol. 2015;31:128–44.Google Scholar
  7. 7.
    Liu H, Li WZ, Wang XY, Pei YG, Long XY, Chen CY, et al. A rare case of extra-adrenal pheochromocytoma localized to the ovary and detected via abdominal computed tomography angiography. Oncol Lett. 2015;9:774–6.CrossRefGoogle Scholar
  8. 8.
    Mc Cluggage WG, Young RH. Paraganglioma of the ovary: report of three cases of a rare ovarian neoplasm, including two exhibiting inhibin positivity. Am J Surg Pathol. 2006;30:600–5.CrossRefGoogle Scholar
  9. 9.
    Jain V, Yadav J, Satapathy AK. Pheochromocytoma presenting as diabetes insipidus. Indian Pediatr. 2013;50:1056–7.Google Scholar
  10. 10.
    Nagakawa H, Mizuno Y, Harada E, Morikawa Y, Kuwahara K, Saito Y, et al. Brain natriuretic peptide counteracting the Renin-angiotensin-aldosterone system in accelerated malignant hypertension. Am J Med Sci. 2016;352:534–39.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2019

Authors and Affiliations

  • Manish Kumar
    • 1
    Email author
  • Aashima Dabas
    • 1
  • Vivek Manchanda
    • 2
  • Nidhi Mahajan
    • 3
  • Kaustuv Mitra
    • 1
  1. 1.Department of PediatricsChacha Nehru Bal Chikitsalaya, Geeta ColonyNew DelhiIndia
  2. 2.Department of Pediatric SurgeryChacha Nehru Bal ChikitsalayaNew DelhiIndia
  3. 3.Department of PathologyChacha Nehru Bal ChikitsalayaNew DelhiIndia

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