Catastrophic Cardiac Hypokinesis and Multiple-Organ Failure After Surgery in a Patient With an Undiagnosed Pheochromocytoma: Emergency Excision of the Tumor

Siddik-Sayyid, Sahar M.; Dabbous, Aliya; Shaaban, Jamil; Daaboul, Dima G.; Baraka, Anis

doi:10.1053/j.jvca.2006.08.008

Cited by 15 publications

(7 citation statements)

References 17 publications

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“…Surgical resection is the only curative treatment for PPGL. Surgery itself, however, may evoke a massive release of catecholamines from a PPGL into the circulation, resulting in potentially life-threatening cardiovascular complications, including hypertensive crises, cardiac arrhythmias, myocardial infarction, pulmonary oedema and multiorgan failure [82,83]. In addition, the rapid drop in catecholamines after resection of the PPGL may result in severe hypotension [84].…”

Section: Presurgical and Surgical Management Of Phaeochromocytoma And Paragangliomamentioning

confidence: 99%

Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

Lenders

Kerstens

Amar

et al. 2020

Journal of Hypertension

215

324

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Section: Presurgical and Surgical Management Of Phaeochromocytoma And Paragangliomamentioning

confidence: 99%

Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

Lenders

Kerstens

Amar

et al. 2020

Journal of Hypertension

215

324

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show abstract

“…In selecting an appropriate treatment option, it was necessary to balance the desire for a durable repair for the patient’s aortic valve pathology while being cognizant of the serious and potentially lethal cardiovascular morbidity that can occur during uncontrolled catecholamine release from the pheochromocytoma. Complications that have been previously described include acute myocarditis, cardiac failure, Takotsubo/reverse Takotsubo cardiomyopathy, arrhythmias and aortic dissection [ 14 – 17 ]. Furthermore, use of cardiopulmonary bypass and systemic anticoagulation in the setting of a pheochromcytoma added unique considerations, including increased catecholamine levels after establishing bypass, potential hemorrhage in the tumor with retroperitoneal bleeding and severe hypertension and tachycardia after separation from cardiopulmonary bypass [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

A case report of an open aortic valve replacement followed by open adrenalectomy in a patient with symptomatic pheochromocytoma and critical aortic stenosis

Feinstein

Lee

Khan

et al. 2021

J Cardiothorac Surg

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Background Pheochromocytoma is a rare medical condition caused by catecholamine-secreting tumor cells. Operative resection can be associated with significant hemodynamic fluctuations due to the nature of the tumor, as well as associated post-resection vasoplegia. To allow for cardiovascular recovery before surgery, patients require pre-operative alpha-adrenergic blockade, which would be limited in the setting of co-existent severe aortic stenosis. In this report, we describe a patient with severe aortic stenosis and symptomatic pheochromocytoma. Case presentation A 51-year-old man with severe aortic stenosis (valve area 0.8 cm2) was found to have a highly active 4 × 4 cm left adrenal pheochromocytoma. Alpha-adrenergic blockade for his pheochromocytoma was limited by syncope in the setting of his aortic stenosis. Open aortic valve replacement (AVR) was performed, followed by adrenalectomy the next day. The perioperative course for each surgical procedure was hemodynamically volatile, exacerbated by severe alcohol withdrawal. During the adrenalectomy, cardiogenic and vasoplegic shock developed immediately after securing the vascular supply to his tumor. This shock was refractory to vasopressin and methylene blue, but responded well to angiotensin II and epinephrine. After both surgeries were completed, his course was further complicated by severe ICU psychosis, ileus, fungal bacteremia, pneumonia/hypoxic respiratory failure and atrial fibrillation. He ultimately recovered and was discharged from the hospital after 38 days. Conclusion To our knowledge, this is the first report of surgical AVR and pheochromocytoma resection in a patient with critical aortic stenosis. The appropriate order and timing of surgeries when both these conditions co-exist remains controversial.

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“…The only curative approach for PPGL is surgical resection, ideally minimally invasive (16). Excessive intraoperative catecholamine release can cause severe hemodynamic instabilities and associated complications (26). The Endocrine Society Guidelines therefore recommend premedication with αadrenergic receptor blockade for patients with hormone-active PPGLs (27).…”

Section: Discussionmentioning

confidence: 99%

Unclear Retroperitoneal Tumors, an Interdisciplinary Challenge – A Case Report and Review of the Literature

Traub

Haggemüller

Baumann

et al. 2021

Preprint

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BackgroundUnclear retroperitoneal tumors still impose major challenges for clinicians. Tumors can originate primarily from retroperitoneal tissue or secondarily invade into the retroperitoneal space. While benign lesions also occur, malignant tumors are far more common. Clinical presentation often depends on replacement or invasion of other organs and is therefore highly variable. The heterogeneous tumor composition makes a definitive preoperative diagnosis difficult. Nevertheless, surgical resection is the gold standard for treatment but often proves challenging due to frequent involvement of large retroperitoneal vessels.Case presentationWe present a case report of a 70-year old woman diagnosed with a large, unclear retroperitoneal tumor. Initial clinical symptoms were increasing dyspnea and dysphagia in our clinic. Gastroenterologic and cardiologic workup was unremarkable. Computed Tomography (CT) revealed a large retroperitoneal mass in the right upper abdomen with severe displacement of the inferior vena cava and renal veins. Without signs of irresectability, the patient was scheduled for tumor resection. The procedure was challenging due to the vessel involvement and large blood pressure alterations during tumor mobilization. The post-op pathologic workup then revealed the rare finding of a completely resected paraganglioma. The post-surgical course was uneventful. One year after diagnosis, the patient is relapse-free.CconclusionThis case impressively shows the challenges of retroperitoneal tumors and the importance of interdisciplinary work in these cases.

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Catastrophic Cardiac Hypokinesis and Multiple-Organ Failure After Surgery in a Patient With an Undiagnosed Pheochromocytoma: Emergency Excision of the Tumor

Cited by 15 publications

References 17 publications

Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

A case report of an open aortic valve replacement followed by open adrenalectomy in a patient with symptomatic pheochromocytoma and critical aortic stenosis

Unclear Retroperitoneal Tumors, an Interdisciplinary Challenge – A Case Report and Review of the Literature

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