Exercise induced hypertension in a 15 year old

[Ontherun]

I am writing about my 15 year old son.  Last August, he collapsed at the end of a XC race (3.1 miles).  Prior to collapsing, he felt severe cramping in arms and legs.  Never lost consciousness, but was unable to walk unassisted, having blurry vision. Coach reported  pulse was too fast to count.  When  did not recover with fluids and ice (heat was not a factor-- was a cool morning), EMTs were called.  When  checked (10-15 minutes after  collapse), bp was 94/36.  He did slowly feel better, but later  complained of a bad headache.  Workup has been an "ologist oddyssey".  Peds cardiologist did EKG, Echo--both normal, but when stressed, test was stopped when his bp went to 220/60 when only walking fast. Renal workup--renal ultrasound, labs (including plasma metanephrines) also normal. 24 hour bp monitor averaged 110/70--but showed spikes with any activity.  Endo workup--Abd MRI, 24 hr urine for all sorts of metabolites, blood work all normal.  Explanation by ped cardiologist is "unusual response to exercise";  has put my son on 5 mg Vasotec bid.  Repeat stress test on Vasotec showed bp elevation to 188/60 when running hard.  Has been cleared to return to exercise;now running track.  (He is a well trained athlete--now 5'9", 126#--but over past 2 years has grown quickly from 5'3", 96#)

1.  Are we missing anything?  Peds cardiologist says my son is first pt he has seen with this.  He is scheduled for another EKG,Echo,stress in August, but we are thinking about a second opinion in Cleveland.
2.  Is this  precursor to hypertension? Any comments/advice are greatly appreciated.

[CCF-M.D.-RCJ]

ontherun,

Thanks for the post.

Q1:"1. Are we missing anything? Peds cardiologist says my son is first pt he has seen with this. He is scheduled for another EKG,Echo,stress in August, but we are thinking about a second opinion in Cleveland."

I am not a pediatrician.  The best advice would be to see someone who likely has seen something like this before, which will be at a big center.  If I saw an adult with these symptoms, I would evaluate them for a coarctation of the aorta, a pheochromocytoma, as well as renal artery stnosis.  Sometimes a pheochromocytoma can be hard to find, even if you are looking for it.

Q2:"Is this precursor to hypertension? Any comments/advice are greatly appreciated"

In adult patients, exericse-induced hypertension frequently can be a precursor to hypertension, but I would surmise that something other than pre-hypertension is the cause in this case.

Best of luck.

[Ontherun]

Thank you very much for your advice.