Coexistence of pheochromocytoma with uncommon vascular lesions

Abstract

Background:Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities.Materials and Methods:From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed.Results:Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation.Conclusion:There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.

Coexistence of pheochromocytoma with abdominal aortic aneurysm: An untold association

“…[78910] Two aspects make our report unusual: (i) the coexistence of pheochromocytoma with AAA in the patient and (ii) although there are case reports citing the association between pheochromocytoma and AAA,[111213] to our sincere belief, this is the first such report citing this uncommon association from India.…”

“…[6] Treatment depends on the size of the lesion. Although previous reports of AAA in association with pheochromocytoma exist in the literature,[789] a similar coexistence has not been reported in Indian patients till date. We report the case of a patient who presented with mutual existence of these two conditions.…”

Abdominal Aortic Aneurysm and Pheochromocytoma

“…The concomitant presentation of AAA and pheochromocytoma is unusual. In one relatively selected review of 50 patients with pheochromocytoma, one had concurrent AAA which did not require intervention [7]. It has been theorized that the presence of pheochromocytoma increases the risk of AAA development and rupture [3,8].…”

Bilateral renal artery stenosis and pheochromocytoma an uncommon association: A case report

“…[9] Surgical resection of the tumor is the treatment of choice and usually cures the hypertension. Careful preoperative treatment with alpha and beta blockers is required to control blood pressure and prevent intraoperative hypertensive crises.…”