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Nutcracker phenomenon
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==ME/CFS & dysautonomic comorbidities== Hammami et al. (2017) published a case-study of a young man with a seven-year history of chronic fatigue syndrome, chronic pelvic pain syndrome, and vague abdominal pain. He also had orthostatic hypotension, “slowed thinking”, an inability to exercise without feeling lightheaded, and he showed a possible tachycardic response during a tilt table test. He was found to have imaging characteristics consistent with nutcracker phenomenon. He underwent surgery to insert a left renal vein stent, and his symptoms resolved soon after the intervention.<ref name="Hammami2017" /> Takahashi, Ohta et al. (2000) describes 9 children with CFS or [[idiopathic chronic fatigue]] who were often absent from school with suspected psychosomatic disorders.<ref name="Takahashi2000ped" /> The children had a broad range of symptoms including chronic fatigue, headache, abdominal pain, unrefreshing sleep, muscle pain, joint pain, sore throat, [[low-grade fever]], afebrile chills in hot summer, [[depression]], postural tachycardia, orthostatic hypotension, dizziness, lightheadedness and other autonomic dysfunction symptoms, some reported [[fibromyalgia]]-type pain, and some reported proteinuria.<ref name="Shin2006">{{Cite journal | last = Shin | first = Jae Il | last2 = Lee | first2 = Jae Seung | date = May 2006 | title = Comment on Gastrointestinal Symptoms Associated with Orthostatic Intolerance|url=https://journals.lww.com/jpgn/Fulltext/2006/05000/Comment_on_Gastrointestinal_Symptoms_Associated.23.aspx|journal=Journal of Pediatric Gastroenterology and Nutrition|language=en-US|volume=42|issue=5 | pages = 588|doi=10.1097/01.mpg.0000215310.71040.c0|issn=0277-2116|pmc=|pmid=|quote=|access-date=|via=}}</ref><ref name=":3" /><ref name="Takahashi2000ped" /> Takahashi, Ohta et al. investigated the cause of the orthostatic proteinuria and found that the children had severe nutcracker phenomenon (NC). Further investigation revealed that nutcracker phenomenon was present in all 9 children with CFS, including those without orthostatic proteinuria.<ref name="Takahashi2000ped" /> They concluded: :''"Their symptoms filled the criteria of chronic fatigue syndrome or idiopathic chronic fatigue (CFS/CF). An association between severe NC and autonomic dysfunction symptoms in children with CFS/CF has been presented."''<ref name="Takahashi2000ped">{{Cite journal | last = Takahashi | first = Y. | last2 = Ohta | first2 = S. | last3 = Sano | first3 = A. | last4 = Kuroda | first4 = Y. | last5 = Kaji | first5 = Y. | last6 = Matsuki | first6 = M. | last7 = Matsuo | first7 = M. | date = Mar 2000 | title = Does severe nutcracker phenomenon cause pediatric chronic fatigue?|url=https://www.ncbi.nlm.nih.gov/pubmed/10749295|journal=Clinical Nephrology|volume=53|issue=3|pages=174–181|issn=0301-0430|pmid=10749295}}</ref> Takahashi, Ohta et al. point out that in their experience the classic symptom of renal bleeding (presenting as micro or macro-hematuria) was not present in children with CFS-associated nutcracker phenomenon.<ref name=":3" /><ref name="Takahashi2000ped" /> Takahashi, Ohta et al. suggested possible ways in which nutcracker phenomenon might affect autonomic function: # severe congestion in the kidney may cause the expansion of the renal venous bed, which would affect the renin-angiotensin system. # severe congestion in the adrenal medulla, which is innervated by sympathetic nerves, may disturb a complex set of central neural connections controlling the sympathoadrenal system. # alternatively, overproduction or night retention of catecholamines might be responsible for the various symptoms of pediatric chronic fatigue syndrome.<ref name="Takahashi2000ped" /><ref name="Shin2006" /><ref name=":3" /><br /> Takahashi et al. (2000) describes a 13-year-old girl who suffered from orthostatic hypotension, tachycardia and chronic fatigue syndrome.<ref name="Takahashi2000a" /> The patient was also diagnosed with nutcracker phenomenon, and was successfully treated with transluminal balloon angioplasty of the compressed left renal vein between the aorta and superior mesenteric artery. Both her dysautonomia and CFS improved after the intervention.<ref name="Shin2006" /><ref name="Takahashi2000a" />
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