Diagnostic Considerations in Pheochromocytoma and Chronic Hemodialysis: Case Report and Review of the Literature

Abstract

We present a patient on long-term hemodialysis (LTH) discovered to have a pheochromocytoma. A thorough workup pertaining his catecholamine status was performed, and intraoperative catecholamine changes were monitored. This condition poses some analytical difficulties as both interpretation of plasma catecholamine measurements and determination of their metabolic products are impaired. The literature about catecholamines with respect to hemodialysis is reviewed, and the known cases of pheochromocytoma in LTH patients are discussed. Predialysis norepinephrine concentrations were almost consistently elevated though less than 3-fold when compared to normal controls. Epinephrine is not significantly different in both groups. At least a 3.3-fold increase of epinephrine or norepinephrine in LTH patients with adrenal pheochromocytomas is observed. We conclude that plasma epinephrine elevations can be evaluated in the conventional manner, and norepinephrine concentrations beyond a 3-fold elevation should raise the suspicion of a pathological catechol excess syndrome. The interpretation of plasma homovanillic acid and vanillylmandelic acid in this condition is complicated by the lack of data in LTH patients without pheochromocytoma. Markedly elevated baseline concentrations for these parameters are assumed.

Four Cases of Pheochromocytoma in Patients with End-stage Renal Disease

“…Stumvoll et al (19) noted that in patients with pheochromocytoma receiving long-term HD, CA concentrations were at least 3.3 times higher than the normal values. Therefore, rises in CA concentrations greater than 3 times above normal in patients receiving long-term HD suggest pheochromocytoma.…”

Plasma metanephrines in renal failure

“…Plasma measurements may also be compromised by increased sympathetic outflow or dependence of catecholamine metabolite levels on clearance by the kidneys [9, 10]. These problems are particularly acute in end-stage renal disease (ESRD), when patients are functionally anephric and on dialysis [11]. There 668…”

Successful treatment of pheochromocytoma in a patient with hemodialysis: a case report and review of the literature

“…Stumvoll et al found the NE level was elevated in HD patients, by around 3-fold but never more than that, and the DA level was increased about 2-fold. 10 The E level was not significantly different between the HD group and the control group. Therefore, among long-term HD patients whose plasma CA level increases three times above normal, pheochromocytoma must be considered.…”

“…To our knowledge, 18 cases of pheochromocytoma in association with ESRD have been reported in the English literature (Table 2), [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and resection was performed successfully in all cases. The patients involved were 10 men and eight women, aged 25-59 years (mean age 42.8 years).…”