Extra-adrenal pheochromocytoma: An unusual cause of deep vein thrombosis

Stevenson, Susan; Ramani, Vijay; Akhtar, Nasim

doi:10.1016/j.jvs.2005.05.013

Cited by 18 publications

(14 citation statements)

References 10 publications

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“…In another case, central venous thrombosis occurred in conjunction with pheochromocytoma and diabetes insipidus [6]. Additionally, a left ilio-femoral venous thrombosis was reported in a patient with pheochromocytoma within the organ of Zuckerkandl [7]. Besides venous thrombosis, cardiac thrombosis has been reported in only three cases.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report

2011

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IntroductionPheochromocytoma is a rare cause of hypertension but it could have severe consequences if not recognized and treated appropriately. The association of pheochromocytoma and thrombosis is even rarer but significantly increases management complexity, morbidity and mortality. To the best of our knowledge, this is the first report of a patient with pheochromocytoma presenting with left axillary arterial and intracardiac thrombus.Case presentationA 47-year-old Caucasian woman with a past medical history of hypertension presented for medical attention with left arm numbness. Doppler ultrasound showed an obstructing thrombus in her left axillary artery. She had symptom resolution after stent placement in her left axillary artery. A subsequent echocardiogram demonstrated a large intracardiac mass and abdominal computed tomography revealed a 7 cm mass between her spleen and left kidney. Labile blood pressure was noted during admission and she had very high levels of plasma and 24-hour urine catecholamines and metanephrines tests. A (123)I- metaiodobenzylguanidine scan showed intense uptake in the left abdominal mass. After adequate alpha blockage with phenoxybenzamine, laparoscopic tumor resection was performed without complications. She had normal metanephrines and complete symptom resolution afterwards. The intracardiac mass also disappeared with anticoagulation. All other endocrine laboratory abnormalities returned to normal after surgery.ConclusionArterial and ventricular thrombosis occurring in patients with pheochromocytoma is rare. A multi-disciplinary approach is necessary in caring for this type of patient. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of pheochromocytoma is the key to improving outcome.

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Section: Discussionmentioning

confidence: 99%

Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report

2011

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“…As recently reviewed, adrenergic infusions increase fV activity, fVIII activity, vWf antigen, t-PA antigen and plasmin-α2-antiplasmin complexes, mainly mediated by endothelial β-adrenoceptors (most likely β2-receptors), leading to an activation of both the coagulation and fibrinolytic system [63,67]. However, only a few published case reports report an association between pheochromocytoma and venous thrombosis, in which other mechanisms have been claimed, such as paraneoplastic polycythaemia and vascular compression [68][69][70]. These apparently conflicting data could be explained by considering overactivity of the sympathetic nervous system as a physiological mechanism to protect the organism from deleterious bleeding in a 'fight or flight' situation [63].…”

Section: Other Endocrine Disordersmentioning

confidence: 99%

The coagulation system in endocrine disorders: A narrative review

et al. 2007

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Endocrine disorders can influence the haemostatic balance. Abnormal coagulation test results have been observed in patients with abnormal hormone levels. Also unprovoked bleeding or thrombotic events have been associated with endocrine disease. The aim of the present review is to summarise the available evidence on the influence of common endocrine disorders on the coagulation system, and their possible clinical implications. We focus on thyroid dysfunction, hyper- and hypocortisolism and growth hormone disturbances, while other endocrine disorders are only briefly discussed. In the published literature a clear bleeding diathesis has only been associated with overt hypothyroidism, mainly mediated by an acquired von Willebrand syndrome. A clinically relevant hypercoagulable state may be present in patients with hyperthyroidism, hypercortisolism or abnormal growth hormone levels, but adequate prospective clinical studies are lacking. Also effects of pheochromocytoma, hyperprolactinaemia and hyperaldosteronism on the coagulation system have been described. It is apparent that unprovoked bleeding and thrombotic episodes can be secondary to endocrine disorders.

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“…Cervical tumors are typically nonfunctional and the presenting symptoms are a palpable mass or pain; in contrast, retroperitoneal tumors have symptomatology related to excessive catecholamine production (hypertension, palpitations, diaphoresis, headache, etc). Intraabdominally, extra-adrenal PH/PGL arise from the paraspinal ganglia of the sympathetic trunk, which includes the organ of Zuckerkandl, located at the aortic bifurcation as in this case [18]. The literature suggests extraadrenal pheochromocytomas may have a higher prevalence in children (30%) vs adults (10%) [19].…”

Section: Discussionmentioning

confidence: 86%