Management of Pheochromocytoma in Dakar: Diagnostic and Therapeutic Advances throughout 16 Cases

Abstract

Introduction: Management of pheochromocytoma faces different challenges leading to misdiagnosis and therapeutic delay in developing countries. The aim of our study was to evaluate the diagnostic and therapeutic features as well as the evolution of our management strategies in hospital setting in recent years in Dakar. Patients and Method: We carried out a retrospective study over 12 years (January 2005 to June 2017), in 4 hospitals in Dakar. We only included patients with established diagnosis of pheochromocytoma upon clinical, biological, radiological and histological arguments. Results: During this period, 16 observations have been collected and were all about female patients. The mean age at the time of diagnosis was 36.81 years. The clinical signs were dominated by hypertension found for 14 patients. At biological examination, hypersecretion catecholamine was found in 13 patients, high urinary metanephrines in 7 patients, high plasmatic metanephrines in 2 patients and raised urinary Vanyl Mandelic Acid (VMA) in 4 patients. Dosage of chromogranin A showed high level for one patient. Abdominal CT scan allowed making the adrenal origin of tumors precise. One patient presented bilateral pheochromocytoma. Before being treated surgically, all patients had had medical preparation. The surgical treatment by median laparotomy consisted of an enucleation of the tumor in 2 patients, and adrenal resection in 11patients.The evolution after surgery was favorable in 12 patients out of 13. One patient died 2 days after surgery by hemodynamic instability. In 2 patients who presented metastases, multidrug therapy with cyclophosphamide, vincristine and dacarbazine was decided after a multidisciplinary meeting, but they died before treatment. Conclusion: Management of pheochromocytomas in developing countries is obviously improving, but the mortality rate remains high. Early diagnosis and perioperative care are to be targeted for better outcome and prognosis of this rare tumor in our areas.

Surgery for Pheochromocytoma: A Single‐Center Review of 60 Cases from South Africa

“…All major postoperative adverse events occurred in the patients undergoing open resection, with the exception of one laparoscopic case that had a relook for suspected intra‐abdominal sepsis; the relook laparoscopy was non‐therapeutic and the patient recovered uneventfully. Perioperative mortality for PPGL is uncommon, with the 1% found in this series in keeping with 0–6% found elsewhere [8–10, 12, 14, 15, 17, 21]. The patient had a symptomatic 7 cm tumor on the left side which was found to completely encase the celiac trunk.…”

“…Although well described in developed nations, there is a paucity of data on the presentation and surgical management of PPGL in developing world contexts, particularly in Sub-Saharan Africa [14][15][16][17].…”

“…Malignancy rates from the first world series range from 2 to 6% and from 5 to 23% in developing world series, with the highest rate in a similar series from South Africa [9–11, 14, 15, 17, 18]. Although a number of factors, including extra‐adrenal location, familial syndrome and larger size, have been reported to be associated with malignant PPGL, none of these has been consistently reported [3, 22].…”

“…PPGL has been well described in developed nations [6][7][8][9][10][11][12][13]. There is, however, a paucity of data on the presentation and surgical management of PPGL in developing nations, particularly in Africa [14][15][16][17]. Series from the developing world have reported a larger mean tumor size, which may be accounted for by delayed presentation and referral [15,18].…”

Overview of Adrenals Tumors in Dakar Hospitals

“…This unusual clinical presentation could be attributed to the large size of AT in our patients, 20 had AT of between 4 and 10 cm, and 10 had tumours larger than 10 cm. The large size of the tumours could also explain the performance of abdominal ultrasound in our study [13], which was performed in 15 patients (42%) and consistently revealed an adrenal mass. CT is often the preferred initial imaging approach for adult adrenal evaluation due to its widespread availability, reproducibility, good temporal resolution, and superior spatial resolution compared with MR imaging.…”