Clinical Experience with Pheochromocytoma in a Single Centre Over 16 Years

Cotesta, Dario; Petramala, Luigi; Serra, Valentina; Pergolini, Mario; Crescenzi, E.J.; Zinnamosca, Laura; Toma, Giorgio De; Ciardi, Antonio; Carbone, Iacopo; Massa, Rita; Filetti, Sébastiano; Letizia, Claudio

doi:10.2165/11530430-000000000-00000

Cited by 33 publications

(31 citation statements)

References 41 publications

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“…According to literature data [ 20 , 31 – 33 ], LA is indicated in patients affected by PCC up to 8 cm, incidentalomas up to 6 cm and metastases <6 cm. Thanks to the use of ultrasound or radiofrequency dissection, we also demonstrated that minimal invasive approach can be safely performed by experienced surgeons also in the treatment of benign tumors larger than 6 cm and in case of metastases, extending the previous surgical indications [ 5 , 6 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Single center experience with laparoscopic adrenalectomy on a large clinical series

et al. 2018

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BackgroundLaparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies.MethodsPre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn’s disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies.ResultsOne hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn’s disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100–180) during the learning curve adrenalectomies and 96.5 min (range 75–110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60–280) and 90.5 ml (range 50–200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile.ConclusionsLaparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Single center experience with laparoscopic adrenalectomy on a large clinical series

et al. 2018

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“…Hypertension, either paroxysmal or sustained, is the most consistent finding in neoplasms, and the classical triad of symptoms (headache, palpitations, and diaphoresis) is present in more than 50% of patients. 2 In severe cases, a patient can present with myocardial infarction, heart failure, pulmonary oedema, arrhythmias, or intrachranial hemorrhage. The coexistence of PHEO and Parkinson's disease or Parkinsonism is very rare, with only 3 cases reported in literature.…”

Section: Introductionmentioning

confidence: 99%

Adrenal Pheochromocytoma Incidentally Discovered in a Patient With Parkinsonism

et al. 2015

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To evaluate the diagnostic route of pheochromocytoma (PHEO) in a patient under dopaminergic treatment.A 70-year-old man with Parkinsonism and under treatment with levodopa and carbidopa came to our observation for evaluation of arterial hypertension and right adrenal mass discovered incidentally.To evaluate adrenal hormone levels we performed a dexamethasone suppression test, plasma aldosterone levels and 24-hr urinary metanephrine, which revealed elevated levels of catecholamines metabolities. 123-I-metaiodobenzylguanidine SPECT scintiscan revealed raised activity within the right adrenal gland concordant with the mass. The diagnosis of PHEO was posed and an elective laparoscopic adrenalectomy was performed; histopathological examination confirmed the PHEO diagnosis.Recently the coexistence of PHEO and Parkinsonism is a very rare association of diseases, with only 3 cases reported in literature. In this article, another case is reported and diagnostic procedures are discussed.

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“…Various phenotypical presentation depends on various productions of catecholamine metabolites, such as 3methoxytyramine, normetanephrine and metanephrine, and eventually a mixed combinations of their secretion [1]. Conversely, about 1% of catecholamine-secreting tumors result asymptomatic, representing an incidental finding [2].…”

Section: Discussionmentioning

confidence: 99%

Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature

Petramala

Bisogni

Olmati

et al. 2019

Preprint

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Purpose . Starting from the description of two interesting cases, we wondered to review the literature on pelvic and bladder paragangliomas (PGLs) in order to illustrate clinical characteristics and current management, lightening the needed of a prompt diagnosis to avoid the onset of several complications. Although PGLs may arise at any site where physiologically chromaffin tissue exists, pelvic origins are not frequent (less than 2%), and the most common localization is the retroperitoneal space, whereas bladder PGLs account for less than 0.06% of all bladder neoplasms and less than 1% of all PGLs. Methods . We herein performed a brief review of the literature about pelvic PGLs in the PubMed library, conducted according to the PRISMA statement, including studies published from 1954 to 2019. We also discuss clinical presentation, morphologic appearance, and management of two cases of pelvic PGL, both of them characterized by an history of paroxysmal high blood pressure episodes uncontrolled by antihypertensive therapy associated with disabling symptoms, not clearly understood for many years. Results . Overall, we evaluated 108 case reports. The majority were females, presenting typical signs and symptoms, such as arterial hypertension (54.2%), hematuria (35.1%), and headache (33.6%). After treatment, the clinical and biochemical remission was evident in only 55% of analyzed cases. Conclusions . For their singular localization, pelvic and bladder PGLs often might be misdiagnosed. The significant delay in the proper treatment could be responsible for the relative low percentage of complete clinical and biochemical remission.

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Clinical Experience with Pheochromocytoma in a Single Centre Over 16 Years

Abstract: These data from a large cohort of patients are consistent with those reported in the literature and show that pheochromocytoma is an in important challenge for clinicians.

Cited by 33 publications

References 41 publications

Single center experience with laparoscopic adrenalectomy on a large clinical series

Single center experience with laparoscopic adrenalectomy on a large clinical series

Adrenal Pheochromocytoma Incidentally Discovered in a Patient With Parkinsonism

Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature

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