Changing trends in the management of phaeochromocytoma

Geoghegan, J. G.; Emberton, Mark; Bloom, S R; Lynn, John A.

doi:10.1046/j.1365-2168.1998.02875.x

Cited by 29 publications

(14 citation statements)

References 15 publications

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“…The reported recurrence rate of clearly benign tumors varies between 0 and 8%, in part depending on how malignancy is defined (7,8,29,30). In a recent retrospective review of 85 consecutive patients with pheochromocytomas and abdominal paragangliomas who underwent surgery at the Karolinska Hospital between 1976 and 1999, none of the 71 patients with tumors initially classified as benign using AFIP criteria had recurrence after a median follow-up time of 144 months (range, 7-287; 28).…”

Section: Discussionmentioning

confidence: 99%

KI-67 AND hTERT Expression Can Aid in the Distinction between Malignant and Benign Pheochromocytoma and Paraganglioma

et al. 2003

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The clinical and histopathological distinction between benign and malignant pheochromocytomas and paragangliomas is difficult, and reliable diagnostic markers are lacking. Here we have evaluated the prognostic value of human telomerase reverse transcriptase (hTERT) gene expression detected by reverse transcription PCR (RT-PCR); telomerase activity (TA) measured by TRAP (telomeric repeat amplification protocol) assay; immunohistochemical staining for Ki-67/MIB-1; and the mRNA expression of matrix metalloproteinase (MMP)-2 and EMMPRIN (extracellular matrix metalloproteinase inducer) analyzed by in situ hybridization in 32 primary pheochromocytomas or abdominal paragangliomas. hTERT was expressed in 7/11 malignant tumors (defined as presence of metastasis and/or extensive local invasion) as compared with in 2/21 benign tumors. All of the benign tumors showed <1% proliferative activity, as measured by Ki-67/MIB-1 staining. In all three patients with malignant tumors who developed metastases and/or invasive local recurrence during follow-up, the tumors were positive for either hTERT expression or Ki-67/MIB-1 immunoreactivity. TA was not a significant discriminator between benign and malignant tumors, and the value of EMMPRIN and MMP-2 as predictive markers was limited. In conclusion, the findings imply that the combined use of Ki-67/ MIB-1 and hTERT, in addition to histopathology, provides a highly specific tool to identify benign pheochromocytoma and abdominal paraganglioma cases that are not at risk of developing recurrent or metastatic disease.

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Section: Discussionmentioning

confidence: 99%

KI-67 AND hTERT Expression Can Aid in the Distinction between Malignant and Benign Pheochromocytoma and Paraganglioma

et al. 2003

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“…The medical history of patients with pheochromocytomas prior to detection ranges from 10 to 52 months [6,22,24,29,30]. The duration of clinical signs is generally shorter than hypertensive history [7,16,31], which is reported to be from three to five years [7,16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Differences between Benign and Malignant Pheochromocytomas.

et al. 2001

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Abstract. Most pheochromocytomas can be cured by resection. In view of the unfavourable prognosis for surgical therapy in cases of late tumour detection and malignant tumours, the aim of the present study is to differentiate between typical signs and symptoms of malignant versus benign pheochromocytomas. We investigated the records of 133 patients retrospectively . In cases of benign tumours (104 of 133, mean age 42± 15.8 years) tumour size was 5.9±3.4 cm, and history was 47.4±75.4 months. 7.7% of the tumours were extraadrenal, and 77% had paroxysmal manifestations. The other 29 patients (mean age: 39.2±21.9 years) had malignant lesions (tumour size: 9.4±5.9 cm (p=0.0022); history: 7.4±5.6 months (p=0.0137); extraadrenal: 24.1% (p=0.0219); paroxysmal: 37.9% (p=0.0012)). Symptoms of patients with benign tumours were hypertension (80%), headaches (42.3%), sweating (30.8%), tachycardia (26%) and pallor (24% (Malignant: Hypertension 46%, p=0.0873; headaches 11%, p=0.0008; sweating 11 %, p=0.0196; tachycardia 14%, p = 0.1961 and pallor 0%, p=0.0010). Abdominal pain and dorsalgia occurred more frequently in malignant pheochromocytomas (26% versus 7%, p = 0.0014). Unusually short histories and extraadrenal localization appear to be suspicious for malignancy. The "typical" clinical signs and symptoms occur more frequently in patients with benign tumours and can therefore be regarded as typical signs of benign pheochromocytomas. Malignant pheochromocytomas are more difficult to treat owing to local inoperability arising from either organ invasion or metastasis. A remission rate of up to 30% has been reported in response to radiotherapy with [1311]-meta-iodobenzylguanidine

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“…1 The most common side effect of phenoxybenzamine is postural hypotension. 9 Beta-blockade can be given after starting alpha-blockade, if tachycardia or other cardiac arrhythmias develop. 10 Beta-blockers must never be started prior to adequate alpha-blockade, since in the absence of beta-2-mediated vasodilation, profound unopposed alpha-mediated vasoconstriction may lead to hypertensive crisis or pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous infusion of magnesium (keeping plasma levels <2 µg/mL to avoid potentiation with muscle relaxation) reduces catecholamine levels, blunts the response to intubation, and effectively controls blood pressure. 1,9 Postoperative administration of inotropic agents concomitant with the administration of intravenous fluids are necessary to correct hypotension due to catecholamine withdrawal and intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed Pheochromocytoma: The Anesthesiologist Nightmare

Myklejord¹

2004

Clinical Medicine & Research

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A male, 62 years of age, presented to the operating room for the removal of a right adrenal mass. Induction of anesthesia triggered a severe hypertensive crisis resistant to high doses of nitroprusside, nitroglycerin and labetalol. The crisis was ultimately resolved with the administration of 5 mg bolus of phentolamine. Surgery was canceled, the patient was transported to the intensive care unit with a continuous drip of phentolamine.High urinary and plasma catecholamines suggested the presence of pheochromocytoma. Three weeks of oral phenoxybenzamine therapy subsequently allowed uneventful induction of anesthesia and open adrenalectomy. Pathologic examination of the resected adrenal tissue confirmed the presence of pheochromocytoma.Anesthetic drugs can exacerbate the life-threatening cardiovascular effects of catecholamines secreted by pheochromocytomas. Treating patients preoperatively with α-adrenergic blockade is helpful for reducing intraoperative hypertensive episodes. Postoperative administration of inotropic agents to correct hypotension due to catecholamine withdrawal may be required. Management of patients with pheochromocytoma remains a challenge for the anesthesiologist, despite the advent of new drugs and techniques.

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Changing trends in the management of phaeochromocytoma

Abstract: Improved imaging of phaeochromocytoma obviates the need for transperitoneal exploration, allowing selected phaeochromocytomas to be successfully managed using an extraperitoneal approach.

Cited by 29 publications

References 15 publications

KI-67 AND hTERT Expression Can Aid in the Distinction between Malignant and Benign Pheochromocytoma and Paraganglioma

KI-67 AND hTERT Expression Can Aid in the Distinction between Malignant and Benign Pheochromocytoma and Paraganglioma

Clinical Differences between Benign and Malignant Pheochromocytomas.

Undiagnosed Pheochromocytoma: The Anesthesiologist Nightmare

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