Clinicopathologic Characteristics of Incidentally Identified Pheochromocytoma

Wachtel, Heather; Cerullo, Isadora; Bartlett, Edmund K.; Roses, Robert E.; Cohen, Debbie L.; Kelz, Rachel R.; Karakousis, Giorgos C.; Fraker, Douglas L.

doi:10.1245/s10434-014-3933-x

Cited by 16 publications

(6 citation statements)

References 26 publications

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“…Thus, more highly concentrated stores of catecholamines in some tumors and associated higher rates of catecholamine secretion may contribute to why some patients with similarly sized PPGLs are diagnosed on the basis of signs and symptoms while others present as incidentalomas. This conclusion is consistent with other reports of lower indices of catecholamine production and secretion in patients with PPGLs presenting as incidentalomas than for other reasons (5,12).…”

Section: Discussionsupporting

confidence: 93%

“…Whereas previously affected patients were mainly diagnosed based on signs and symptoms, today the tumors are increasingly found incidentally as part of imaging studies for purposes unrelated to suspicion of PPGL (6,11,12). Due to recognition of an increasing number of pathogenic mutations and a high rate of disease recurrence, PPGLs are now being found during surveillance screening in patients with a genetic predisposition or past history of disease (11).…”

Section: Introductionmentioning

confidence: 99%

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Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion

Geroula

Deutschbein

Langton

et al. 2019

European Journal of Endocrinology

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Objective Hypertension and symptoms of catecholamine excess are features of pheochromocytomas and paragangliomas (PPGLs). This prospective observational cohort study assessed whether differences in presenting features in patients tested for PPGLs might assist establishing likelihood of disease. Design and methods Patients were tested for PPGLs because of signs and symptoms, an incidental mass on imaging or routine surveillance due to previous history or hereditary risk. Patients with (n = 245) compared to without (n = 1820) PPGLs were identified on follow-up. Differences in presenting features were then examined to assess the probability of disease and relationships to catecholamine excess. Results Hyperhidrosis, palpitations, pallor, tremor and nausea were 30–90% more prevalent (P < 0.001) among patients with than without PPGLs, whereas headache, flushing and other symptoms showed little or no differences. Although heart rates were higher (P < 0.0001) in patients with than without PPGLs, blood pressures were not higher and were positively correlated to BMI, which was lower (P < 0.0001) in patients with than without PPGLs. From these differences in clinical features, a score system was established that indicated a 5.8-fold higher probability of PPGLs in patients with high than low scores. Higher scores among patients with PPGLs were associated, independently of tumor size, with higher biochemical indices of catecholamine excess. Conclusions This study identifies a complex of five signs and symptoms combined with lower BMI and elevated heart rate as key features in patients with PPGLs. Prevalences of these features, which reflect variable tumoral catecholamine production, may be used to triage patients according to likelihood of disease.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion

Geroula

Deutschbein

Langton

et al. 2019

European Journal of Endocrinology

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“…Previous studies reported that patients with incidentally identified PPGLs had a lower prevalence of hypertension. 34,35 However, our study has several limitations. First, this was a retrospective study spanning a 6-year period.…”

Section: Discussionmentioning

confidence: 90%

Predictors of prolonged hypotension requiring vasopressor support after resection of pheochromocytoma and paraganglioma

Shu

Lan

Zhang

et al. 2021

Clinical Endocrinology

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Objective: Prolonged hypotension is a common complication after resection of pheochromocytoma (PCC) or paraganglioma (PGL). The objective of our study was to identify preoperative or intraoperative clinical factors that can predict prolonged hypotension after PCC/PGL resection.Patients and Methods: A total of 414 patients who underwent resection of PCC or PGL at our institution between January 2013 and January 2020 were included.Patients were divided into two groups according to whether or not vasopressor support was required postoperatively. Associations between preoperative and intraoperative variables and prolonged hypotension were evaluated.Results: Two hundred and one (48.6%) patients had postoperative hypotension that required vasopressor support with a median duration of 20 h. Multivariable analysis demonstrated that increased 24-h urinary norepinephrine (NE) levels (odds ratio[OR] = 1.091, 95% confidence interval [CI]: 1.052-1.132, p < .001), longer operative time (OR = 1.008, CI: 1.004-1.011, p < .001) and lower preoperative phenoxybenzamine dose (OR = 0.336, CI: 0.150-0.753, p = .008) were predictors of prolonged hypotension. Moreover, operative time, body mass index, 24-h urinary level of NE and preoperative phenoxybenzamine dose were significantly correlated with the duration of postoperative vasopressor support.Conclusions: Increased urine NE level, longer operative time and lower preoperative phenoxybenzamine dose were predictors of prolonged hypotension requiring vasopressor support. Clinicians can identify these factors to manage their patients better and prevent severe complications.

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“…12 This age disparity was attributed to a delay in diagnosis secondary to the atypical symptoms of incidentally identified pheochromocytoma patients. Conversely, in our study, the incidental aldosteronoma patients presented with typical symptoms, and a majority met the Endocrine Society criteria for a targeted workup for primary hyperaldosteronism based solely on the severity of hypertension or the presence of hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Incidental and Intentional Medicine Achieve Similar Results in Primary Hyperaldosteronism

et al. 2015

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Clinicopathologic Characteristics of Incidentally Identified Pheochromocytoma

Abstract: Half of patients presenting for surgical resection of pheochromocytoma were identified incidentally. These patients had equivalent rates of malignancy and pathologic traits associated with malignant potential and require definitive evaluation and early surgical referral.

Cited by 16 publications

References 26 publications

Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion

Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion

Predictors of prolonged hypotension requiring vasopressor support after resection of pheochromocytoma and paraganglioma

Incidental and Intentional Medicine Achieve Similar Results in Primary Hyperaldosteronism

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