Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal

Bihain, Florence; Nomine-Criqui, Claire; Guerci, Philippe; Gasman, Stéphane; Klein, Marc; Brunaud, Laurent

doi:10.3390/cancers14163845

Cited by 8 publications

(10 citation statements)

References 55 publications

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“…Nevertheless, there was no difference between SAB and NSAB in terms of time of out-of-target BP during resection, and it could not be established whether its use was associated with a better clinical outcome (including hypotension, vasopressor requirements, cardiovascular complications and mortality). According to recent studies, no difference has been reported between alpha blockade vs. no blockade in terms of mean SBP, HR, cardiovascular morbidity or mortality [36,37], hence the systematic pharmacological preparation has been questioned [38,39].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

Araujo-Castro,

García Sanz,

Mínguez Ojeda

et al. 2023

Journal of Hypertension

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Purpose: To identify presurgical and surgical risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs). Methods: Retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. Intraoperative hypertensive crisis was defined as systolic blood pressure (SBP) greater than 200 mmHg lasting more than 1 min and postoperative hypertensive crisis as SBP greater than 180 mmHg or diastolic blood pressure (DBP) greater than 110 mmHg. Results: A total of 296 surgeries were included. Alpha presurgical blockade was employed in 93.2% of the cases and beta-adrenergic in 53.4%. Hypertensive crisis occurred in 20.3% (n = 60) of the surgeries: intraoperative crisis in 56 and/or postoperative crisis in 6 cases (2 cases had both types of crises). We identified as risk factors of intraoperative hypertensive crisis, absence of presurgical glucocorticoid therapy (odds ratio [OR] 3.48; 95% confidence interval [CI] 1.19–10.12) higher presurgical SBP (OR 1.22 per each 10 mmHg, 95% CI 1.03–1.45), a larger tumor size (OR 1.09 per each 10 mm, 95% CI 1.00–1.19) and absence of oral sodium repletion (OR 2.59, 95% CI 1.25–5.35). Patients with hypertensive crisis had a higher rate of intraoperative bleeding (P < 0.001), of intraoperative hemodynamic instability (P < 0.001) and of intraoperative hypotensive episodes (P < 0.001) than those without hypertensive crisis. Conclusion: Intraoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients not pretreated with glucocorticoid therapy before surgery, with larger tumors and higher presurgical SBP and who do not receive oral sodium repletion had a higher risk for developing hypertensive crisis during and after PPGL surgery.

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Section: Discussionmentioning

confidence: 99%

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

Araujo-Castro,

García Sanz,

Mínguez Ojeda

et al. 2023

Journal of Hypertension

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“…Indeed, in our patient, the significant ketoconazole-induced reduction in cortisol secretion led to satisfactory BP control on antihypertensive drugs. After the biochemical diagnosis of pheochromocytoma, a selective alpha-blocker was added, and after a few days, a beta-blocker was restarted in order to control reflex tachycardia ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Catastrophic ACTH-secreting pheochromocytoma: an uncommon and challenging entity with multifaceted presentation

Foppiani

Poeta

Rutigliani

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Cushing’s syndrome due to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) by a pheochromocytoma is a challenging condition. A woman with hypertension and an anamnestic report of a ‘non-secreting’ left adrenal mass developed uncontrolled blood pressure (BP), hyperglycaemia and severe hypokalaemia. ACTH-dependent severe hypercortisolism was ascertained in the absence of Cushingoid features, and a psycho-organic syndrome developed. Brain imaging revealed a splenial lesion of the corpus callosum and a pituitary microadenoma. The adrenal mass displayed high uptake on both 18F-FDG PET/CT and 68Ga-DOTATOC PET/CT; urinary metanephrine levels were greatly increased. The combination of antihypertensive drugs, high-dose potassium infusion, insulin and steroidogenesis inhibitor normalized BP, metabolic parameters and cortisol levels; laparoscopic left adrenalectomy under intravenous hydrocortisone infusion was performed. On combined histology and immunohistochemistry, an ACTH-secreting pheochromocytoma was diagnosed. The patient's clinical condition improved and remission of both hypercortisolism and catecholamine hypersecretion ensued. Brain magnetic resonance imaging showed a reduction of the splenial lesion. Off-therapy BP and metabolic parameters remained normal. The patient was discharged on cortisone replacement therapy for post-surgical hypocortisolism. EAS due to pheochromocytoma displays multifaceted clinical features and requires prompt diagnosis and multidisciplinary management in order to overcome the related severe clinical derangements. Learning points A small but significant number of cases of adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome are caused by ectopic ACTH secretion by neuroendocrine tumours, which is usually associated with severe hypercortisolism causing severe clinical and metabolic derangements. Ectopic ACTH secretion by a pheochromocytoma is exceedingly rare but can be life-threatening, owing to the simultaneous excess of both cortisol and catecholamines. The combination of biochemical and hormonal testing and imaging procedures is mandatory for the diagnosis of ectopic ACTH secretion, and in the presence of an adrenal mass, the possibility of an ACTH-secreting pheochromocytoma should be taken into account. Immediate-acting steroidogenesis inhibitors are required for the treatment of hypercortisolism, and catecholamine excess should also be appropriately managed before surgical removal of the tumour. A multidisciplinary approach is required for the treatment of this challenging entity.

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“…Pagrindinis šių neuroendokrininių navikų gydymas yra chirurginis naviko šalinimas, atliekant adrenalektomiją, pirmenybę teikiant laparoskopinei chirurginei intervencijai [1][2][3]6]. Siekiant valdyti galimas komplikacijas, pacientai su neuroendokrininiais navikais turi būti detaliai ištirti, įvertinant naviko dydį, lokalizaciją, galimą metastazavimą.…”

Section: įVadasunclassified

“…Tyrimo rezultatai Priešoperacinis paruošimas: diagnostikos ypatumai ir valdymas. PPGL diagnozės nustatymas pradedamas nuo metanefrinų, normetanefrinų kraujo plazmoje ar paros šlapime biocheminių tyrimų [1][2][3]6,7]. Galimas 3-metoksitiramino tyrimo įtraukimas, nustatant dopaminą produkuojančias PPGL [11,12].…”

Section: Feochromocitoma Ir Paraganglioma Anesteziologijoje Periopera...unclassified

“…Perioperacinio valdymo ramstis − priešoperacinė alfa adrenoreceptorių blokada, kurios įdiegimas į gydymą nuo 1960 m. siejamas su sumažėjusiu operaciniu mirštamumu nuo 30-40 proc. iki mažiau nei 3 procentų [1,[6][7][8]. Alfa receptorių blokadą rekomenduojama inicijuoti 7-14 d. prieš suplanuotą operaciją.…”

Section: Feochromocitoma Ir Paraganglioma Anesteziologijoje Periopera...unclassified

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Feochromocitoma Ir Paraganglioma Anesteziologijoje. Perioperacinio Valdymo Rekomendacijos

Skaraitė¹,

Jašinskas²,

Macas³

2023

Health Sciences

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Feochromocitomos ir paragangliomos yra reti katecholaminus produkuojantys neuroendokrininiai navikai. Pagrindinis šių navikų gydymas yra radikalus chirurginis naviko šalinimas. Dėl šių navikų fiziologijos, susietos su katecholaminų (adrenalino, noradrenalino ar dopamino) hipersekrecija, neužtikrinus tinkamo priešoperacinio paruošimo, chirurginės operacijos metu gali įvykti sunkios kardiovaskulinės komplikacijos. Perioperacinio valdymo ramstis − priešoperacinė alfa adrenoreceptorių blokada, kurios įdiegimas į gydymą nuo 1960 m. siejamas su sumažėjusiu operaciniu mirštamumu nuo 30-40 proc. iki mažiau nei 3 procentų. Šiems pacientams reikalingas detalus ištyrimas, individualaus priešoperacinio paruošimo plano sudarymas, įtraukiant daugiadalykes komandas, ir nuoseklios perioperacinės priežiūros užtikrinimas specializuotuose gydymo centruose. Stengiantis prisidėti prie šių pacientų perioperacinės priežiūros gerinimo, atlikta literatūros apžvalga, nagrinėjanti aktualiausias tarptautines gaires ir mokslinę literatūrą. Šioje apžvalgoje apibendriname argumentuotus perioperacinio valdymo aspektus ir dažniausiai siūlomas rekomendacijas.

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Management of Patients with Treatment of Pheochromocytoma: A Critical Appraisal

Cited by 8 publications

References 55 publications

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

Catastrophic ACTH-secreting pheochromocytoma: an uncommon and challenging entity with multifaceted presentation

Feochromocitoma Ir Paraganglioma Anesteziologijoje. Perioperacinio Valdymo Rekomendacijos

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