Recent Developments in the Diagnosis and Treatment of Pheochromocytoma

Sheps, Sheldon G.; Jiang, Nai-Siang; Klee, George G.; Heerden, Jon A. van

doi:10.1016/s0025-6196(12)62113-2

Cited by 149 publications

(85 citation statements)

References 21 publications

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“…Paragangliomas of the bladder present with the clinical symptoms of pheochromocytoma, which include headaches, palpitations and fainting as a result of the induction of catecholamine release from functional bladder paragangliomas when urinating (6). A proportion of patients present with the clinical symptoms of bladder tumors, such as hematuria .…”

Section: Introductionmentioning

confidence: 99%

Non-functioning paraganglioma occurring in the urinary bladder: A case report and review of the literature

Peng

Xiong

et al. 2015

Oncology Letters

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Abstract. Paraganglioma, also termed extra-adrenal pheochromocytoma, may be observed at the base of the skull and neck as well as within the mediastinum and periaortic region. The clinical symptoms of paraganglioma of the urinary bladder include intermittent hypertensive attacks, micturition, headaches and palpitations due to high catecholamine levels; these types of paragangliomas are extremely rare. However, certain bladder paragangliomas do not present with any of these symptoms; thus, surgeons are not pre-warned on how to prepare for their resection. Surgery to remove pheochromocytomas may therefore result in an intraoperative hypertensive crisis and increase the mortality rate. This infrequent type of paraganglioma is only recognized through histo logical examination following surgery. The current study reports the case of a 61-year-old male with urinary bladder paraganglioma. The patient presented with hypertension, which was controlled to within a normal range using diovan and norvasc treatment; in addition, the patient's blood pressure was not altered with urination or postural changes. The patient was not administered an α-blocking agent or a blood volume expander prior to the surgery, and during the partial cystectomy no hypertensive crisis occurred.

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Section: Introductionmentioning

confidence: 99%

Non-functioning paraganglioma occurring in the urinary bladder: A case report and review of the literature

Peng

Xiong

et al. 2015

Oncology Letters

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“…9 The occurrence of neurological symptoms, including a preoperative stroke in this patient, increased her perioperative risk and complicated her anaesthetic management.…”

Section: Discussionmentioning

confidence: 95%

“…A recent review of patients with an unsuspected phaeochromocytoma coming to the operating room stated that 27% of them died from hypertensive or hypotensive crisis occurring during a minor operation.~ In contrast, the operative mortality of patients with known disease and preoperative preparation has recently been reported as 1.3%. 9 Neurological symptoms, though less common, have been reported. Thomas et al in a series of 100 patients described I I patients with transient visual abnormalities ranging from snowy vision to almost complete visual loss.…”

Section: Discussionmentioning

confidence: 99%

The anaesthetic management of a patient with a phaeochromocytoma and acute stroke

Fox

Manninen

1991

Can J Anaesth

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A case is reported of a young woman in whom the diagnosis of a phaeochromocytoma was made after a major stroke. Preoperative preparation included the introduction of phenoxybenzamine, i0 rag" day -t , ancl propranolol, 80 rag. day -t , over a two-week Phaeochromocytoma is a rare tumour with an incidence of approximately 0.13% in the general population. ~ Neurological events can complicate the diagnosis and treatment of these patients. 2-5 Although the anaesthetic management of a patient with a phaeochromocytoma has been well described previously, 6-9 the management of a patient with a phaeochromocytoma and a recent cerebral infarction has not. Case reportA 26-yr-old, 55 kg female nurse with a ten-day history of recurrent headaches was transferred from a local hospital for investigation. The headaches were increasing in frequency and unresponsive to medical therapy. Before transfer her vital signs had been normal except for one recorded systolic blood pressure of 200 mmHg.Her past medical history included occasional palpitations which were not associated with syncope. She had received L-thyroxin for treatment of hypothyroidism for the previous year. This medication was stopped prior to her transfer in an attempt to eliminate it as a contributing factor to her headaches. On admission, she demonstrated marked orthostatic changes in blood pressure and heart rate; supine blood pressure was 110/60 mmHg and heart rate 85 beats per minute (bpm); sitting blood pressure 80/50 mmHg; and heart rate was 150 bpm. The remainder of her physical examination, including an extensive neurological assessment, was unremarkable. Routine laboratory investigations including complete blood count, electrolytes, serum glucose, blood urea nitrogen, and creatinine concentrations were normal. A 12-lead electrocardiogram (ECG) revealed diffuse nonspecific ST segment and T wave changes.Shortly after admission to the neurological observation unit she had several episodes of transient neurological dysfunction ranging from blurred vision to motor and CAN J ANAESTH 1991 / 38:6 / pp775-9

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“…Pain is one of the most unpleasant symptoms for a patient with bone metastasis [13], and is effectively lessened by external radiation [14][15][16]. Effective doses were reported to be a total of 40 Gy or more, and of 4 Gy or more at one time [14,16,17].…”

Section: Discussionmentioning

confidence: 99%

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Teno

Tanabe²,

Nomura³

et al. 1996

Endocr J

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Abstract. Hypertension and norepinephrine hypersecretion in a 59-year-old woman suffering from malignant pheochromocytoma with multiple metastases were appropriately controlled with a-and 13-blockers, and a-methyltyrosine (a-MT), a catecholamine-synthesis inhibitor. Metastasized vertebrae were treated with external radiation to relieve pain, but this treatment had to be interrupted at a total dose of 20 Gy because the patient suffered acutely exacerbated hypertension (200/110 mmHg), tachycardia (160 beats/min) and a low-grade fever. Simultaneously her serum levels of LDH, potassium, urea nitrogen, creatinine, white blood cell count, CRP and norepinephrine were significantly increased, suggesting that this episode was due to radiation-induced tissue destruction and the leakage of catecholamines and possibly interleukin-6, a cytokine mediating inflammation which is reportedly present in pheochromocytoma.The marked hypertension was controlled by continuous iv administration of phentolamine and propranolol. Athough radiation therapy effectively relieves pain due to neoplasmic metastasis to the bone, physicians should be aware that life-threatening complications such as the above occur in malignant pheochromocytoma.Sufficient pretreatment with adrenergic blocking agents and/or cc-MT and careful monitoring of the patient's general condition during radiation therapy, even at a low dose, are highly recommended.

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Recent Developments in the Diagnosis and Treatment of Pheochromocytoma

Cited by 149 publications

References 21 publications

Non-functioning paraganglioma occurring in the urinary bladder: A case report and review of the literature

Non-functioning paraganglioma occurring in the urinary bladder: A case report and review of the literature

The anaesthetic management of a patient with a phaeochromocytoma and acute stroke

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

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