Abstract 691

Hypertension in the infant is uncommon and usually associated with renovascular or parenchymal disease, coarctation, or aortic thrombosis. We report a three-month-old youngster with an unsuspected femoral fracture due to child abuse who presented as unexplained acute hypertension.

HB was a 12-week-old male born at 40 weeks gestation following an uncomplicated pregnancy. There was no umbilical artery catheterization. On the day of admission he had irritability and decreased appetite. Initial physical examination revealed a blood pressure of 179/94 mm Hg. Multiple blood pressures, which were taken at rest and during sleep, exceeded the 95th percentile. Serum electrolytes, creatinine, urea nitrogen and total calcium were normal. Urinalysis showed no red cells, white cells or protein. Plasma aldosterone level was slightly elevated at 142.2 ng/dl (Normal 5-90 ng/dl)and plasma renin activity was elevated at 71.5 ng/ml/h (Normal 0.15-2.33 ng/ml/h). Plasma 11 deoxycortisol, cortisol and angiotension converting enzyme activities as well as urinary dopamine, epinephrine, norepinephrine and homovanillic acid values were normal. A DMSA renal scan was normal as was a renal duplex scan, abdominal ultrasound and abdominal CT scan.

The patient was treated with antihypertensive therapy. On the fourth hospital day, he was noted to have swelling of his right leg associated with tenderness. An acute fracture of the proximal third of the right femur was noted on x-ray. The patient received adequate pain control and was casted without traction but hypertension persisted. He was maintained on Captropril therapy until four months of age. Medicines were discontinued with a blood pressure of 90/45 mm Hg.

Femoral fracture is the likely etiology for hypertension in this infant, all other etiologies being excluded. Child abuse should be considered in the differential diagnosis of infants with unexplained hypertension.