Postoperative Management in Patients with Pheochromocytoma and Paraganglioma

Mamilla, Divya; Araque, Katherine A; Brofferio, Alessandra; Gonzales, Melissa; Sullivan, James; Nilubol, Naris; Pacák, Karel

doi:10.3390/cancers11070936

Cited by 36 publications

(37 citation statements)

References 144 publications

(160 reference statements)

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“…As DA concentration increases, DA can act on α and β-ARs, causing variable degrees of hypertension and tachycardia. Therefore, patients with DA-secreting PPGL may present with different manifestations, varying from hypotension to normotension and hypertension ( 8 , 10 , 11 ). CAs synthetic pathway and effects in dose-dependent manner are shown in Figure 1 ( 10 ).…”

Section: Catecholamines and Adrenergic Receptorsmentioning

confidence: 99%

Preoperative Management of Pheochromocytoma and Paraganglioma

Fang

Ding

et al. 2020

Front. Endocrinol.

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Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors, characterized by excessive release of catecholamines (CAs), and manifested as the classic triad of headaches, palpitations, profuse sweating, and a variety of other signs and symptoms. The diagnosis of PPGL requires both evidence of excessive release of CAs and anatomical localization of CA-secreting tumor. Surgery is the mainstay of treatment for all patients with PPGL unless contraindicated. However, without proper preparation, the release of excessive CAs, especially during surgery, can result in lethal cardiovascular complications. Herein, we briefly reviewed the pathogenesis of this disease, discussed the current approaches and evidence available for preoperative management, summarizing the results of the latest studies which compared the efficacies of preoperative management with or without a adrenergic-receptor antagonists, aiming to facilitate better understanding of the preoperative management of PPGL for the physicians.

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Section: Catecholamines and Adrenergic Receptorsmentioning

confidence: 99%

Preoperative Management of Pheochromocytoma and Paraganglioma

Fang

Ding

et al. 2020

Front. Endocrinol.

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“…Adequate preoperative preparation, appropriate anesthesia administration, laparoscopic approach, and the experienced team could be the possible reasons for a low frequency of intraoperative severe hypertension. Tumor manipulation during the resection of pheochromocytoma is thought to be the most probable reason for perioperative hypertension (19). Prolonged hypotension after tumor removal might be due to chronically low circulating levels of plasma volume, an abrupt decrease in the plasma catecholamine levels, downregulation of adrenoreceptors, increased blood loss, and cardiogenic or septic shock (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…Tumor manipulation during the resection of pheochromocytoma is thought to be the most probable reason for perioperative hypertension (19). Prolonged hypotension after tumor removal might be due to chronically low circulating levels of plasma volume, an abrupt decrease in the plasma catecholamine levels, downregulation of adrenoreceptors, increased blood loss, and cardiogenic or septic shock (19,20). Larger tumor size and higher urinary catecholamine metabolite levels are reported as the predictors of prolonged hypotension requiring postoperative catecholamine support (20).…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma: 16 Years of Experience in a Single Center

Saydam¹,

Adiyaman²,

Bozkurt³

et al. 2021

Turk J Endocrinol Metab

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Objective: Reviewing the 16-year experience of pheochromocytoma in a tertiary referral center. Material and Methods: The demographics data and the results of clinical, biochemical, and radiological evaluations of 67 patients who received a diagnosis of pheochromocytoma between the years 2004 and 2020 were obtained retrospectively. Results: The mean age (±SD) of the patients at the time of diagnosis was 46 years (±16.1) with a slight female predominance. The percentage of patients diagnosed due to complaints was 50.8%, while 31.2% were diagnosed during the adrenal incidentaloma screening, and 18% were diagnosed during screening for hereditary conditions. Pre-existing hypertension was detected in 56.7% of the patients, while 11.9% of the patients were diagnosed to have hypertension at the time of diagnosis. Paroxysmal pattern was observed in 53.7% of the patients and was accompanied by the classical triad of palpitation (32.8%), headache (20.9%), and sweating (14.9%) as the leading symptoms. Median tumor size was 40 mm (range: 9-90 mm) and the lesion size correlated significantly (p<0.001) with the urinary catecholamine metabolite levels. The overall rate of hemodynamic instability in both perioperative and postoperative periods was 6%. Hereditary syndromes, including multiple endocrine neoplasia type 2A (MEN 2A), MEN 2B, von Hippel-Lindau (VHL), and neurofibromatosis type 1 (NF1), were diagnosed in 24% of these patients. Hereditary pheochromocytomas were diagnosed at younger ages, and bilateral lesions were more prevalent in hereditary pheochromocytomas (p=0.003 and p<0.001, respectively). In addition, patients with hereditary pheochromocytomas were more asymptomatic rather than sporadic (p=0.016). Metastasis was detected in 3% of these patients. Conclusion: Pheochromocytoma is a rare, life-threatening condition, and therefore, it is important to suspect and test for pheochromocytoma in patients with clinical suspicion. In addition, hereditary syndromes associated with pheochromocytomas should be considered while evaluating patients with pheochromocytoma. A lifelong annual follow-up is recommended for the detection of recurrent or metastatic disease, and its evaluation, treatment, and follow-up should involve a multidisciplinary approach in experienced centers.

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“…Administration of volume expanders and antihypotensive drugs noradrenaline, phenylephrine, vasopressin, or dopamine would be critical in treating hypotension after tumor removal [18]. Fourth, attention should be focused on the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels after operation [19]. When encountered intraoperatively with undetected catecholamine secreting PPGL, we should immediately perform adequate hemodynamic monitoring, prepare appropriate vasoactive agents, and give an appropriate amount of fluid treatment.…”

Section: Discussionmentioning

confidence: 99%

A case of an unexpected posterior mediastinal functional paraganglioma: case report and literature review

2020

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Background: Paraganglioma can be found in a wide range of locations. However, paraganglioma in the posterior mediastinum is rare. An unexpected paraganglioma located in the posterior mediastinum was found during surgery. The anesthesia management of this patient was challenging. Case presentation: A 65-year-old male with a posterior mediastinal tumor was scheduled for thoracoscopic mediastinal tumor resection. Severe hemodynamic changes during the operation and postoperative pathological diagnosis showed that the patient had a rare case of posterior mediastinal functional paraganglioma, which was not found before the operation. Although the patient did not experience side effects after surgery, he did experience a dangerous surgical process. Conclusions: The correct diagnosis of paraganglioma, intensive preoperative screening, adequate preoperative preparation, and accurate intraoperative anesthesia management could provide better anesthesia for paraganglioma patients.

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Postoperative Management in Patients with Pheochromocytoma and Paraganglioma

Cited by 36 publications

References 144 publications

Preoperative Management of Pheochromocytoma and Paraganglioma

Preoperative Management of Pheochromocytoma and Paraganglioma

Pheochromocytoma: 16 Years of Experience in a Single Center

A case of an unexpected posterior mediastinal functional paraganglioma: case report and literature review

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