Pheochromocytoma: Update on Diagnosis, Localization, and Management

Werbel, Sandra S.; Ober, K. Patrick

doi:10.1016/s0025-7125(16)30088-8

Cited by 140 publications

(96 citation statements)

References 118 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypertension is paroxysmal only in 50% of the cases and is persistent in the rest which makes diagnosis difficult. 4 Pheochromocytomas have been rarely associated with acute myocardial infarction. Most of these cases have normal coronaries.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma Presenting As Acute Myocardial Infarction

Narayanapillai

Shanmugavel

2015

Nepalese Heart J.

View full text Add to dashboard Cite

Pheochromocytomas are rare neuro-endocrine tumors arising from chromaffin cells of the sympathetic nervous system.Pheochromocytomacan have diverse clinical presentations, which makes the diagnosis often difficult. We present a case of adrenalpheochromocytoma presenting as acute ST elevation myocardial infarction (STEMI). Catecholamine surge in patients with pheochromocytoma can cause myocardial infarction in the absence of atherosclerotic coronary artery disease. Pheochromocytoma presenting as acute myocardial infarction is very rare and it occurs in young individuals. This is a rare case report of pheochromocytoma in an elderly male presenting with acute STEMI successfully treated by resection of tumor.Key words: pheochromocytoma, myocardial infarction, catecholamines, hypertension Case ReportA 62 year old farmer presented with severe epigastric discomfort, vomiting and profuse sweating. He was hypertensive and diabetic since last four years poorly compliant on treatment. His blood pressure was 190/110 mmHg and heart rate was 60 beats per minute. Precordial examination was unremarkable except for a loud fourth heart sound. Initial ECG showed tall peaked T waves in precordial leads suggesting hyperacute changes of myocardial infarction. Subsequent ECGs showed loss of R waves with coved ST elevation and T wave inversion in leads V2,V3 and V4. Leads I,II,III,aVF, V5 and V6 showed T wave inversions (Fig 1). His echocardiogram showed severe hypokinesia of apical interventricular septum and apex with normal left ventricular systolic function.He was subjected to an immediate coronary angiogram with intention for primary percutaneous revascularization. Surprisingly his diagnostic coronary angiogram showed normal epicardial coronary arteries and no evidence of atherosclerosis (Fig 2).So he was treated conservatively with antiplatelet agents, nitroglycerine and statins.In his subsequent ECG sprecordial ST segment returned to baseline with deep T wave inversions, typical of serial evolutionary changes of STEMI. Cardiac enzymes were elevated, serum troponin I of 9ng/ml, (normal cut off is less than 0.05ng/ml).During the hospital stay he developed recurrent episodes of similar but less intense episodes of abdominal discomfort and vomiting. His blood pressure increased to levels as high as 200/120 mm of Hg during the episodes along with sinus tachycardia. This prompted us to suspect an alternative diagnosis in this case. His thyroid function tests were normal. In view of the labile hypertensive changes, we also considered the possibility of pheochromocytoma and proceed with an ultra sonogram of the abdomen which showed a mass in the region of right suprarenal gland. 24 hr urine metanephrine levels were elevated (14.5 mg, normal value < 1 mg/24 hrs). A contrast enhanced CT scan of abdomen showed right suprarenal mass which was a well encapsulated with a fluid level (Fig 3). Both kidneys and left suprarenal gland were normal. Thus we arrived at a diagnosis of pheochromocytoma and the acute myocardial infarction was pr...

show abstract

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma Presenting As Acute Myocardial Infarction

Narayanapillai

Shanmugavel

2015

Nepalese Heart J.

View full text Add to dashboard Cite

show abstract

“…Complications which are being associated with the operation technique by many authors. That's why many doubts existed before the introduction of laparoscopic method in the surgery of pheochromocytoma (5,10,11).…”

Section: Discussionmentioning

confidence: 99%

“…The situations initiating the hypertensive crisis, from a surgeon's point of view are: diagnostic examinations like the pressure on the abdominal cavity, tests carried with metoclopramide, ACTH and deksametazone also anesthetic and operative procedures. The hypertensive crisis can lead to the multiorgan insufficiency and encephalopathy (10,13,14).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

Otto

Dzwonkowski

Januszewicz

et al. 2010

Polish Journal of Surgery

View full text Add to dashboard Cite

the aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains. The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra-and post-operative complications associated with performed operation. Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach. Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.

show abstract

“…The majority of these tumors arise in the adrenal medulla (1), and when they occur outside the adrenal gland they are known as an extra-adrenal pheochromocytoma or a paraganglioma (2). Pheochromocytoma is primarily sporadic, but may additionally be associated with multiple endocrine neoplasia syndrome (3) and mutations of mitochondrial complex 2 succinate dehydrogenase enzymes (4).…”

Section: Introductionmentioning

confidence: 99%

Pheochromocytoma of the pancreas: A report of three cases and a literature review

Ding¹,

Min²,

He³

et al. 2016

Oncology Letters

View full text Add to dashboard Cite

Abstract. Pheochromocytoma is primarily derived from the adrenal medulla. The majority of extra-adrenal pheochromocytoma cases occur in the superior para-aortic region and para-adrenal area. However, pheochromocytoma originating from the pancreas is rare. The present study reports the cases of three patients who had no history of hypertension but were post-operatively diagnosed with pheochromocytoma located in the pancreas. Of the three patients, two were admitted to hospital due to abdominal pain, and imaging examinations revealed a soft-tissue lesion in the head of pancreas. Local resection of the pancreatic tumor was successfully performed and a diagnosis of pheochromocytoma derived from the pancreas was subsequently made by pathologists. The third patient was admitted to hospital for surgical treatment due to the identification of a continuously growing lesion in the tail of pancreas during physical examinations. Distal resection of the pancreas was stopped during surgery when the patient's blood pressure and heart rate suddenly increased to 180/110 mmHg and 140 beats/min, respectively. Due to a marked rise in noradrenaline and adrenaline levels in the blood subsequent to surgery, the patient was diagnosed with pancreatic pheochromocytoma. The present study additionally reviewed the associated literature concerning pheochromocytoma in order to improve the understanding of this rare clinical phenomenon. The aim of the present study is to highlight to surgeons that although patients may not present with typical clinical manifestations due to the non-functional status of the tumor, undiagnosed pheochromocytoma of the pancreas should be considered when surgeons observe an unexpected hypertensive crisis during pancreatic tumor surgery. IntroductionPheochromocytoma is a catecholamine-secreting tumor that originates from chromaffin cells. The majority of these tumors arise in the adrenal medulla (1), and when they occur outside the adrenal gland they are known as an extra-adrenal pheochromocytoma or a paraganglioma (2). Pheochromocytoma is primarily sporadic, but may additionally be associated with multiple endocrine neoplasia syndrome (3) and mutations of mitochondrial complex 2 succinate dehydrogenase enzymes (4).Extra-adrenal pheochromocytoma has been previously reported to account for ~10% of all pheochromocytoma cases during adulthood and for 30-40% of cases in children (5). These tumors may occur in the superior para-aortic region, the para-adrenal area and the inferior para-aortic region, as well as the organ of Zuckerkandl and the urinary bladder (6-8). Pancreatic localization of extra-adrenal pheochromocytoma is rare, and to the best of our knowledge, only one case has been previously reported in the Chinese literature (9). In the present study, the cases of three patients (Table I) with pheochromocytoma involving the pancreas are presented. To the best of our knowledge, the present report is the first to present three definite and comprehensive cases of this rare clinical phenomenon. In addition, the rele...

show abstract

Pheochromocytoma: Update on Diagnosis, Localization, and Management

Cited by 140 publications

References 118 publications

Pheochromocytoma Presenting As Acute Myocardial Infarction

Pheochromocytoma Presenting As Acute Myocardial Infarction

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

Pheochromocytoma of the pancreas: A report of three cases and a literature review

Contact Info

Product

Resources

About