Undiagnosed Pheochromocytoma Complicated with Perioperative Hemodynamic Crisis and Multiple Organ Failure

Baraka, Anis

doi:10.5772/25963

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…A retrospective case–control study of 109 PPGLs reported significantly more adverse cardiovascular events (cardiac infarctions, angina pectoris and stroke/transient ischaemic attacks) in PCC compared to matched controls: 13.8% vs. 1.1% . Autopsy studies have shown that up to 50% of all PGL are clinically undetected and undiagnosed sympathetic PPGL have high morbidity and mortality at surgery with haemodynamic crisis and organ failure . Data from two retrospective studies suggest that the risk of cardiovascular events is normalized or decreased after radical surgery .…”

Section: Morbidity and Mortality Of Ppglmentioning

confidence: 99%

Genetic testing and surveillance guidelines in hereditary pheochromocytoma and paraganglioma

et al. 2019

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Pheochromocytoma and paraganglioma (PPGL) are rare tumours and at least 30% are part of hereditary syndromes. Approximately 20% of hereditary PPGL are caused by pathogenic germ line variants in genes of the succinate dehydrogenase complex (SDHx), TMEM127 or MAX. Herein we present guidelines regarding genetic testing of family members and their surveillance based on a thorough literature review. All cases of PPGL are recommended genetic testing for germ line variants regardless of patient and family characteristics. At minimum, FH, NF1, RET, SDHB, SDHD and VHL should be tested. In addition, testing of MEN1, SDHA, SDHAF2, SDHC, TMEM127 and MAX is recommended. Healthy first‐degree relatives (and second‐degree relatives in the case of SDHD and SDHAF2 which are maternally imprinted) should be offered carrier testing. Carriers of pathogenic variants should be offered surveillance with annual biochemical measurements of methoxy‐catecholamines and bi‐annual rapid whole‐body magnetic resonance imaging and clinical examination. Surveillance should start 5 years before the earliest age of onset in the family and thus only children eligible for surveillance should be offered pre‐symptomatic genetic testing. The surveillance of children younger than 15 years needs to be individually designed. Our guidelines will provide a framework for patient management with the possibility to follow outcome via national registries and/or follow‐up studies. Together with improved insights into the disease, this may enable optimisation of the surveillance scheme in order to minimise both anxiety and medical complications while ensuring early disease detection.

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Section: Morbidity and Mortality Of Ppglmentioning

confidence: 99%

Genetic testing and surveillance guidelines in hereditary pheochromocytoma and paraganglioma

et al. 2019

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“…It is important to be aware of risk of hemodynamic instability during surgery that can lead to multiorgan failure as a main complication. Preparation should start two weeks prior to surgery and include use of alpha blockers, such as prazosin or phenoxybenzamine in order to provide full alpha adrenergic blockage and restoration of blood volume [6,7]. Later consideration in starting beta blockers is also recommended in order to avoid arrhythmia.…”

Section: Case Reportmentioning

confidence: 99%

Incidentally discovered intrathoracic extra-adrenal pheochromocytoma during preoperative screening

Assumpcao-Morales¹,

Mohan²,

Zahra³

2013

IJCRI

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Introduction: We are reporting a case of an incidental mass later diagnosed as an extradural pheochromocytoma at t2-t4 level during a presurgical work up for a gynecological procedure. Only a few cases of extradural paravertebral tumors are described in literature. case report: this is a clinical case of an asymptomatic 26-year-old female with an incidental finding of thoracic mass in chest X-ray during preoperative screening for myomectomy. Work up for this mass showed elevated plasma and urinary metanephrine levels which was consistent to pheochromocytoma. computed tomography, magnetic resonance imaging and metaiodobenzylguanidine scans demonstrate a mass originating from thoracic spine with cord compression, no adrenal mass, multifocal disease or metastasis. Prior to surgery, the patient was treated with phenoxybenzamine and metoprolol to decrease hemodynamic instability during surgical procedure and also embolization to the arteries supplying the mass to decrease intraoperative bleeding. Patient

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“…1 Caesarean section has been known to induce pheochromocytoma crisis. 2 The excess release of catecholamines by the tumour can induce acute and rapidly progressive haemodynamic disturbance and a series of clinical conditions such as malignant hypertension, 3 Takotsubo cardiomyopathy, 4 and multi-organ failure. Other rare complications of pheochromocytoma crisis are spontaneous rhabdomyolysis and acute renal failure.…”

Section: Introductionmentioning

confidence: 99%

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

et al. 2016

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Pheochromocytoma associated with pregnancy is not common. Caesarean section may induce pheochromocytoma crisis, resulting in a lethal condition. The clinical picture of pheochromocytoma crisis is extremely variable. In this report, we describe a case of severe pheochromocytoma crisis induced by caesarean section presenting with hyperpyrexia, haemodynamic collapse, muscle weakness, heart failure, and acute kidney injury. Furthermore, we report that the muscle weakness was a manifestation of rhabdomyolysis, resulting from the pheochromocytoma crisis. Standard medical therapy failed to halt the patient's rapidly deteriorating condition. Continuous renal replacement therapy removed catecholamines from the circulation, resulting in improvement of haemodynamics and abrogation of rhabdomyolysis.

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Undiagnosed Pheochromocytoma Complicated with Perioperative Hemodynamic Crisis and Multiple Organ Failure

Cited by 5 publications

References 32 publications

Genetic testing and surveillance guidelines in hereditary pheochromocytoma and paraganglioma

Genetic testing and surveillance guidelines in hereditary pheochromocytoma and paraganglioma

Incidentally discovered intrathoracic extra-adrenal pheochromocytoma during preoperative screening

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

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