Editing Pediatrics: Renal and Adrenal Oncology (section)

==== History and Physical Exam ====
* '''Clinical manifestations vary widely'''
** '''<span style="color:#ff0000">Most children have abdominal pain or a palpable mass'''
*** '''Most primary tumors arise within the abdomen (65%)'''
**** Physical examination often reveals a fixed, hard abdominal mass
*** '''Pelvic neuroblastoma arising from the organ of Zuckerkandl account for 4% of tumors.'''
**** Extrinsic compression of the bowel and bladder can produce symptoms of urinary retention and constipation.
** '''<span style="color:#ff0000">Other are identified because of manifestations of metastatic disease, including bone or joint pain and periorbital ecchymosis.'''
*** '''Metastases are present in 70% of patients with neuroblastoma at diagnosis'''
** '''<span style="color:#ff0000">Symptoms produced by catecholamines'''
*** '''<span style="color:#ff0000">Release may mimic those seen in pheochromocytoma: paroxysmal hypertension, palpitations, flushing, and headache'''
*** '''Secretion of vasoactive intestinal peptide (VIP) can produce severe watery diarrhea and hypokalemia'''