The patient, a 12-year-old girl, had been suffering from periodic bouts of sweating, headaches and stomachaches. Over the past two or three months, the child had lost 20 pounds, and she complained about not being able to see well. At one time her blood pressure measured normal, but now it was 220/160, dangerously high. Puzzled by the girl's symptoms, her doctor, a local pediatrician, called Dr. Ellin Lieberman, chief of the nephrology division at Childrens Hospital of Los Angeles.
Even as she listened over the telephone, Lieberman suspected the cause of the problem. When the child was brought into Childrens Hospital for tests, the doctor's hunch was confirmed: The girl was suffering from a very rare, benign tumor that secretes adrenal hormones called a pheochromocytoma. She was given drugs to bring her blood pressure under control and, when her symptoms had subsided, surgery was performed to remove the tumor. She gained back 30 pounds in six weeks, and today, three years later, is doing fine.
On another occasion, a hospital outside of Los Angeles sent a 9-year-old boy to Lieberman for evaluation. The boy was suffering from crippling stomach pains so severe they made him double over. Nothing else seemed to be wrong with him, but his blood pressure was 230/160. When doctors at Childrens performed an arteriogram--a procedure which uses X-rays to trace the course of arteries in the body--they found that the boy had a narrowing of his aorta and of the arteries going to his kidneys. Over the next several years, a surgeon performed a number of operations to bypass the affected arteries. Today, the 9-year-old is a man of 18 years, has no symptoms and his blood pressure is normal.
Although these two patients suffered from very different conditions, what they had in common provided the most important clue to their diagnoses: high blood pressure. Yet only recently has the medical profession come to understand that high blood pressure can be a problem in children as well as adults. Until about 10 years ago, pediatricians seldom took regular blood-pressure readings from their patients.
"It used to be, why bother taking a child's blood pressure?" said Lieberman, one of a handful of national experts on hypertension in children. "And now, the type of dialogue that occurs is, 'I've taken the blood pressure, the results are as follows, what does it mean?' "
Children, like adults, can develop both primary and secondary hypertension. Primary hypertension (which used to be called essential hypertension) has no known cause, but it is often associated with obesity and a high-salt diet. The children of adults with primary hypertension are at a higher risk for the disease, which can lead to heart attacks and strokes if blood pressures are not kept under control.
Secondary hypertension is a byproduct of another underlying condition. In children, the main causes are kidney disease, narrowing of the arteries or hormone imbalances. Once the underlying cause is cured, the blood pressure usually returns to normal.
'Very High Numbers'
Although hypertension does not occur at a high rate in the young--about 1% of children under 12 have high blood pressure--Lieberman said that "one out of 100 children is very high to a pediatrician." Moreover, the prevalence of hypertension increases as children get older, up to 6% in adolescents. "Again," said Lieberman, "we are talking very high numbers for a pediatric population."
Lieberman, 54, was born Ellin Louria in Brooklyn, N.Y. Her father was a distinguished surgeon, and her brother later also became a doctor. Her husband, Harry M. Lieberman, also a pediatrician, works for the Kaiser Permanente group in Los Angeles.
Lieberman attended Radcliffe College and the Boston University School of Medicine. While an intern at Boston University's teaching hospital, she worked with Dr. Robert Wilkins, a pioneer in the treatment of hypertension. In 1959, she came to Childrens Hospital as a fellow in what was then called the metabolics and renal division. In 1967, the unit became the division of nephrology and Lieberman became its head, a position she has held ever since. Lieberman is also a professor of pediatrics at USC Medical School.
Couldn't Find Answers
She first encountered the problem of child hypertension in 1970, when she was trying to treat a 1-year-old child with kidney disease and high blood pressure. "When I went to the scientific literature, I could not find any answers to my set of questions," she recalled. "In contrast to the literature that was available in 1970 concerning adults, there was nothing about that type of case. The mechanisms of hypertension, the prevalence of hypertension, and the management of hypertension in pediatrics was not covered. So you had to go from the ground up, as they say, 'OJT,' on-the-job-training."