Diagnosis of Small Adrenal Pheochromocytomas by Adrenal Venous Sampling with Glucagon Stimulation Test

Mercado-Asis, Leilani B.; Tingcungco, Angelito G.; Bolong, David; Lopez, Rolando A.; Caguioa, Eduardo Vicente; Yamamoto, Milagros E.; Marcos, Joshua; Mercado, Arlene B.; Zacarias, Manuel B.

doi:10.5812/kowsar.1726913x.1951

Cited by 7 publications

(17 citation statements)

References 38 publications

(53 reference statements)

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“…The EPI:NE ratio on the affected side was significantly higher (4.1 vs. 1.5). In suspected bilateral pheochromocytoma, the EPI:NE ratio was similar on both sides (2.42 vs. 2.24) [6]. Majority of patients tolerated the procedure with no untoward events.…”

Section: Bilateral Adrenal Venous Sampling With Glucagon Stimulationmentioning

confidence: 80%

“…The authors have previously described the step by step method of BAVS with glucagon stimulation [6]. The first samples were sent to Specialty Laboratories Inc., Santa Monica, California, USA and then to NUH (National University Hospital) in Singapore for determination of fractionated plasma catecholamines, NE, EPI, and dopamine by HPLC (high-performance liquid chromatography).…”

Section: Bilateral Adrenal Venous Sampling With Glucagon Stimulationmentioning

confidence: 99%

“…The current recommendation on the use of venous sampling is reserved for difficult cases of pheochromocytoma especially in those whose clinical manifestations are episodic, subclinical or in patients with subcentimeter tumors. BAVS (Bilateral adrenal venous sampling) with glucagon stimulation has been proven to be safe and useful in the early diagnosis of pheochromocytoma [6]. In unilateral PHEO, the minimum predictive cut-off value of EPI (epinephrine) and NE (norepinephrine) ratio of the affected vs. unaffected side was 6.8 (sensitivity: 88.9%; specificity: 87.5%) and 3.8 (sensitivity: 90%; specificity: 81.2%), respectively.…”

mentioning

confidence: 99%

“…The EPI:NE ratio on the affected side was significantly higher (4.1 vs. 1.5). In suspected bilateral pheochromocytoma, it has been reported that the EPI:NE ratio was similar on both sides (2.42 vs. 2.24) [6]. The identification of the dominantly secreting adrenal gland can be challenging but highly important, as the removal of the affected or dominant side can markedly improve blood pressure control and halt morbidity and mortality.…”

mentioning

confidence: 99%

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Removal of Dominant Adrenal Lateralized by Glucagon-Stimulated Adrenal Venous Sampling Alleviates Hypertension in Bilateral Pheochromocytoma

2013

JLS

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Abstract:In bilateral pheochromocytoma, localization of the dominant adrenal is challenging but highly important since the removal of dominant side can markedly improve cardiovascular outcomes. To demonstrate the usefulness of glucagon-stimulated BAVS (bilateral adrenal venous sampling) in determining the dominant adrenal to be removed, the authors reviewed records of patients who underwent BAVS with glucagon stimulation from 1997-2010. Nineteen out of 44 patients were diagnosed with bilateral pheochromocytoma. Mean age at diagnosis was 33 ± 14 years. Duration of hypertension was 5 ± 6 years with highest systolic BP (blood pressure) of 186 ± 30 mmHg and diastolic BP of 113 ± 18 mmHg. Headache (68%) is the most common symptom followed by paroxysmal hypertension (58%). Majority were taking  3 anti-hypertensive drugs. On glucagon-stimulated BAVS, 63% had right adrenal dominance. Three patients, who were hypertensive for 1, 6 and 12 years, underwent removal of the dominant adrenal. On follow-up (mean period = 36 months), there was marked improvement in BP control [pre-op vs. post-op: (systolic) 160-240 mmHg vs. 120-150 mmHg; (diastolic) 90-110 mmHg vs. 70-90 mmHg] and reduction in number of anti-hypertensive medications (from 3-5 to 2 classes of drugs). BAVS with glucagon stimulation is a valuable tool in the identification of the dominant adrenal to be removed in patients with bilateral pheochromocytoma to alleviate chronic hypertension.

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Section: Bilateral Adrenal Venous Sampling With Glucagon Stimulationmentioning

confidence: 80%

Section: Bilateral Adrenal Venous Sampling With Glucagon Stimulationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Removal of Dominant Adrenal Lateralized by Glucagon-Stimulated Adrenal Venous Sampling Alleviates Hypertension in Bilateral Pheochromocytoma

2013

JLS

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“…In a study by Asis, et al [7], it showed the value of bilateral adrenal vein sampling (BAVS) with glucagon stimulation to clinch the diagnosis of pheochromocytoma and localize the small tumor. Among the 41 participants, 20 were diagnosed with unilateral pheochromocytoma; 16 were suspected of bilateral adrenal hyperplasia; the remaining 5 patients were considered normal.…”

Section: Discussionmentioning

confidence: 99%

Value of Systemic Hormonal Unloading in Pheochromocytoma

Gan¹,

M²,

Mercado-Asis³

2019

jmust

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Systemic unloading of adrenaline improves blood pressure (BP), but the effect on quality of life is not emphasized. This report aims to examine the outcome of systemic hormonal unloading through unilateral adrenalectomy in three pheochromocytoma cases. Case 1 A 20-year-old male presented with anxiety, severe headaches, and BP 150/100 mmHg, taking terazosin and amlodipine. Stimulated bilateral adrenal venous sampling with glucagon stimulation (SBAVS-GS) showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he is asymptomatic with the usual BP 110-120/60-70 mmHg without medication. Case 2 A 51-year-old male presented with panic attacks, sweating, palpitations, headaches, and BP 220/110 mmHg, given terazosin and amlodipine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he reported a reduction in his symptoms. His usual BP is 100-130/60-80 mmHg on low-dose amlodipine. Case 3 A 27-year-old female presented with severe headache, dizziness, spontaneous epistaxis, palpitations, and BP 210/140 mmHg, taking bisoprolol, terazosin, and clonidine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, she had less headache and dizziness. Her BP is 110-140/70-90 mmHg on a single antihypertensive drug. Conclusion Systemic hormonal unloading via unilateral adrenalectomy of the dominantly hormonal secreting adrenal gland is a good treatment option for pheochromocytoma; consequently, improving quality of life signii cantly.

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Pathophysiology and Mechanisms of Hypertension (Asian Context)

Mercado-Asis

2022

Hypertension and Cardiovascular Disease in Asia

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Diagnosis of Small Adrenal Pheochromocytomas by Adrenal Venous Sampling with Glucagon Stimulation Test

Abstract: BAVS with glucagon stimulation will lead to early diagnosis of microscopic pheochromocytoma, thus preventing chronic complications like atherosclerosis, and untoward events like myocardial infarction and stroke.

Cited by 7 publications

References 38 publications

Removal of Dominant Adrenal Lateralized by Glucagon-Stimulated Adrenal Venous Sampling Alleviates Hypertension in Bilateral Pheochromocytoma

Removal of Dominant Adrenal Lateralized by Glucagon-Stimulated Adrenal Venous Sampling Alleviates Hypertension in Bilateral Pheochromocytoma

Value of Systemic Hormonal Unloading in Pheochromocytoma

Pathophysiology and Mechanisms of Hypertension (Asian Context)

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