Anästhesie bei Patienten mit Phäochromozytom - Eigene Ergebnisse und Übersicht

Adams, Hans Anton; Hempelmann, G.

doi:10.1055/s-2007-998971

Cited by 5 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Die Prävalenz bei Patienten mit essenzieller Hypertonie liegt bei etwa 0,2-0,4% [16]. Der Großteil der Tumoren entstammt dem Nebennierenmark, der Anteil der extraadrenalen Tumoren liegt bei 10-30% (Paragangliome) [1], 15-20% aller Phäochromozytome sind familiärer Genese. Ein gehäuftes Auftreten findet man insbesondere im Rahmen einer multiplen endokrinen Neoplasie (MEN2), dem von-Hippel-Lindau-Syndrom (vHLS), der Neurofibromatose Typ 1 sowie bei familiä-ren Glomustumoren [16].…”

Section: äTiologie Und Pathophysiologieunclassified

Präoperative α-Rezeptoren-Blockade beim asymptomatischen Phäochromozytom? Pro

Bracker

Rath

Dralle

et al. 2012

Chirurg

View full text Add to dashboard Cite

In approximately 90% of all cases a pheochromocytoma causes sustained or paroxysmal hypertension. During surgical resection tumor manipulation can lead to excessive catecholamine release with the risk of life-threatening complications. Since the early 1950s a preoperative medical treatment with an α-adrenoceptor blocking agent has been successfully administered for prevention of hemodynamic instability but not all pheochromocytomas are associated with hypertension. Currently the discovery of asymptomatic pheochromocytomas is more frequent than in the time prior to modern imaging techniques (computed tomography, magnetic resonance imaging). There is little information about this type of pheochromocytoma in the literature. This article discusses the question if preoperative α-adrenoceptor block is also indicated in asymptomatic pheochromocytomas based on the current literature.

show abstract

Section: äTiologie Und Pathophysiologieunclassified

Präoperative α-Rezeptoren-Blockade beim asymptomatischen Phäochromozytom? Pro

Bracker

Rath

Dralle

et al. 2012

Chirurg

View full text Add to dashboard Cite

show abstract

“…Während die meisten Autoren eine alpha-Rezeptorenblockade mit Phenoxybenzamin unter differenzierter Volumentherapie empfehlen [5,7,10,12,13], befürworten andere die alpha-Blockade mit Prazosin und den Einsatz von Phenoxybenzamin nur bei hypertensiven Krisen [1,9]. Die Gruppe um Bravo empfiehlt, möglichst auf eine präopera-tive alpha-Blockade zu verzichten [3,4,6].…”

Section: Der Anaesthesist 9·97unclassified

Intraoperative Diagnose eines multilokulären Phäochromozytoms

et al. 1997

View full text Add to dashboard Cite

Pheochromocytomas are functionally active, catecholamine-secreting tumours of chromaffin tissue. The mainstay of pharmacological therapy is preoperative treatment with oral phenoxybenzamine. This drug irreversibly alkylates alpha-1-adrenergic receptors on vascular smooth muscle and renders them nonfunctional, thereby causing vasodilatation. The duration of action of a single dose is approximately 24 h. Therefore, postoperative hypotension is a hazard of therapy with phenoxybenzamine if adequate plasma volume repletion is not provided. Prazosin, a short-acting, competitive alpha-1 blocker, has been used preoperatively, but has been criticized for its failure to adequately prevent perioperative hypertensive episodes. We report the case of a 73-year-old woman who was admitted for elective pheochromocytoma resection. Preoperative therapy with phenoxybenzamine was impossible because of the patient's refusal to take the drug. Preoperative antihypertensive preparation was therefore performed with prazosin 30 mg/24 h and metoprolol 100 mg/24 h. During the surgical preparation of the tumor, sodium nitroprusside was started at an average infusion rate of 4.1 micrograms/kg/min. After resection of the primary tumor, when the sodium nitroprusside infusion was stopped the patient exhibited an increase in systolic blood pressure (BP) up to 210 mg Hg. This hypertensive crisis was managed with sodium nitroprusside, nitroglycerin, and esmolol. A multilocular pheochromocytoma was diagnosed. Further stimuli due to tumour palpation resulted in repeated increases in BP. In this manner, two additional areas of tumour could be diagnosed by BP peaks after reduction of the sodium nitroprusside infusion. After complete resection of a total of three tumours, no further hypertensive crises occurred. The patient's postoperative course was uneventful. We conclude that in this patient presenting with an unsuspected multilocular pheochromocytoma, the lack of permanent alpha-blockade was probably helpful in allowing complete resection of all the tumours.

show abstract

Pheochromocytoma: presentation, diagnosis and treatment

Reisch

Pęczkowska²,

Januszewicz³

et al. 2006

Journal of Hypertension

210

163

View full text Add to dashboard Cite

Pheochromocytomas are rare, mostly benign catecholamine-producing tumors of chromaffin cells of the adrenal medulla or of a paraganglion. Typical clinical manifestations are sustained or paroxysmal hypertension, severe headaches, palpitations and sweating resulting from hormone excess. However, their presentation is highly variable and can mimic many other diseases. If remaining unrecognized or untreated, they can be a life-threatening condition. Therefore, the most important message of this review is to think of them. The diagnosis of pheochromocytomas depends mainly upon the demonstration of catecholamine excess by 24-h urinary catecholamines and metanephrines or plasma metanephrines. They are localized by a computed tomography scan and magnetic resonance imaging of the adrenal glands and abdomen; complementary 123I-metaiodobenzylguanidine scintigraphy and 18F-dihydroxyphenylalanine-positron emission tomography are available. Because approximately one out of four pheochromocytomas turn out to be hereditary entities, screening for genetic alterations is important. Laparoscopic and adrenal sparing surgical intervention following preoperative alpha-blockade is the treatment of choice and usually curative. In malignant pheochromocytomas, radiotherapy and chemotherapy are palliative treatment options. This review provides an update on identification and management of pheochromocytomas, emphasizing current developments in diagnosis, including genetic testing, pathophysiology and treatment of pheochromocytomas.

show abstract

Anästhesie bei Patienten mit Phäochromozytom - Eigene Ergebnisse und Übersicht

Cited by 5 publications

References 18 publications

Präoperative α-Rezeptoren-Blockade beim asymptomatischen Phäochromozytom? Pro

Präoperative α-Rezeptoren-Blockade beim asymptomatischen Phäochromozytom? Pro

Intraoperative Diagnose eines multilokulären Phäochromozytoms

Pheochromocytoma: presentation, diagnosis and treatment

Contact Info

Product

Resources

About