An unusual case of back pain: A large Pheochromocytoma in an 85 year old woman

Karumanchery, Roopa; Nair, Jagdish; Hakeem, Abdul; Hardy, Robert J.

doi:10.1016/j.ijscr.2011.10.006

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…1,22 Most studies of spinal metastases have shown a postoperative improvement in blood pressure, headaches, palpitations, and anxiety; delayed complications have usually been associated with tumor recurrence or distant metastasis. 11,13,15,33 We demonstrated that en bloc resection in one of our patients (Case 5) was associated with postoperative hypertensive cure. 12 The reasons for this are unknown but may be related to a reduction in the tumor burden and subsequent decrement in catecholamine secretion.…”

Section: Discussionmentioning

confidence: 64%

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Kaloostian

Zadnik

Kim

et al. 2014

SPI

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Pheochromocytomas of the spine are uncommon and require careful preoperative planning. The authors retrospectively reviewed the charts of 5 patients with metastatic spinal pheochromocytoma who had undergone surgical treatment over the past 10 years at their medical center. They reviewed patient age, history of pheochromocytoma resection, extent and location of metastases, history of alpha blockage, surgical level, surgical procedure, postoperative complications, tumor recurrence, and survival. Metastases involved the cervical (1 patient), thoracic (3 patients), and lumbar (2 patients) levels. Preoperative treatment included primary pheochromocytoma resection, chemotherapy, alpha blockade, embolization, and radiation. Three patients had tumor recurrence, and 2 underwent 2-stage reoperations for tumor extension. Hemodynamic complications were common: 2 patients developed pulseless electrical activity arrest within 4 months after surgery, 1 patient had profound postoperative tachycardia with fever and an elevated creatine kinase level, and 1 patient experienced transient postoperative hypotension and paraplegia. One patient died of complications related to disseminated cerebral and spinal disease. With careful preoperative and surgical management, patients with symptomatic metastatic spinal pheochromocytoma can benefit from aggressive surgical treatment. Postoperative cardiovascular complications are common even months after surgery, and patients should be closely monitored long term.

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Section: Discussionmentioning

confidence: 64%

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Kaloostian

Zadnik

Kim

et al. 2014

SPI

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“…The final studies included were case reports or series. Eighteen reports referred to abdominal conditions that mimic spinal diseases ( Table 1 ), 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. 15 Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Mirbagheri

Etminan

Schölch

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Objective: Lower back pain is a frequent cause of Emergency Department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. Patient and Methods: A 79-year-old male presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment four weeks prior to admission. The MRI highlighted multi-segmental hyperintensities in the intervertebral disc spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic and dental examinations turned out negative for a focus of infection. A CT-guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the key words “spondylodiscitis”, “spine”, “abdominal” and “cholecystitis”, to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. Results: No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. Conclusion: Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day seven. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions, respectively. Some had undergone unnecessary invasive surgical procedures before the right diagnosis was concluded. Because of the high incidence of symptoms such as lumbar back pain as well as abdominal pain, considering optimal patient care as well as economic aspects it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.

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“…Including both open and laparoscopic cases, a total of 33 cystic pheochromocytoma !10 cm had sufficient detail regarding perioperative outcomes for inclusion (including current case). Of all patients, 19 had a preoperative diagnosis [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 14 had no preoperative diagnosis. [28][29][30][31][32][33][34][35][36][37][38][39][40] A summary of characteristics of these two groups is shown in Table 3 and demonstrates a striking difference in number and severity of complications, suggesting that careful anaesthetic and surgical planning can have a positive impact on outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incidental giant cystic pheochromocytoma: a case report and review of the literature

2020

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Introduction Pheochromocytoma is a tumour arising from the adrenal medulla, which secretes catecholamines. Approximately 20% of pheochromocytomas are cystic and more likely to be asymptomatic. They should be surgically resected as all have a malignant potential and pose cardiovascular risk. Case presentation: We report the case of a 61-year-old female patient admitted electively for laparoscopic adrenalectomy for a large cystic pheochromocytoma detected incidentally. Diagnosis was confirmed preoperatively by elevated 24-h urinary metanephrines. The patient was treated preoperatively with alpha and beta blockade. Surgery was without complication; she had an uneventful postoperative recovery and no evidence of recurrence at one-year follow-up. Conclusion This case highlights the necessity of investigating for biochemical function in all adrenal lesions by measuring metanephrines, even when entirely cystic on imaging. Given the surgical and anaesthetic risk in resection of pheochromocytoma, attaining a preoperative diagnosis allows for careful preoperative planning and safe surgery.

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An unusual case of back pain: A large Pheochromocytoma in an 85 year old woman

Cited by 9 publications

References 4 publications

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

High incidence of morbidity following resection of metastatic pheochromocytoma in the spine

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Incidental giant cystic pheochromocytoma: a case report and review of the literature

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