Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas

Fagundes, Gustavo F C; Almeida, Madson Q.

doi:10.1210/jendso/bvac004

Cited by 19 publications

(30 citation statements)

References 64 publications

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“…Pheochromocytoma would be diagnosed in the outpatient setting as the patients experience bursts of hypertension episodes associated with sweating, palpitations, and headache secondary to abrupt catecholamine release [ 11 ]. Nevertheless, and mainly through the high interindividual differences in catecholamines sensitivity, there is a poor correlation between the levels of circulating catecholamines and the symptomatic complaints.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed Thyrotoxicosis Storm in a Patient Presenting With a Perioperative Sinus Tachycardia and Hypertensive Crisis After Induction of Anesthesia for Emergent Bipolar Hip Hemiarthroplasty After Traumatic Femur Neck Fracture: A Case Report

Alsayed¹

2022

Cureus

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The clinical picture of sympathetic overdrive under anesthesia can be caused by many syndromes, which should be considered and excluded. Thus, the anesthetist needs a high level of suspicion and vigilance to recognize the diagnosis early and act accordingly. Emphasizing the pitfalls encountered in this exceptional case scenario, we present this rare case of a malnourished patient on antipsychotic medications facing an urgent operation concomitant with a thyroid storm, a situation that can rapidly progress to a decompensating multiorgan failure.

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Section: Discussionmentioning

confidence: 99%

Undiagnosed Thyrotoxicosis Storm in a Patient Presenting With a Perioperative Sinus Tachycardia and Hypertensive Crisis After Induction of Anesthesia for Emergent Bipolar Hip Hemiarthroplasty After Traumatic Femur Neck Fracture: A Case Report

Alsayed¹

2022

Cureus

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“…Among these, sustained or paroxysmal hypertension is the most common sign of pheochromocytoma. 4 For instance, Philips 5 reported that paroxysmal hypertension and sustained hypertension occur in 45% and 50% of patients with pheochromocytoma, respectively, and only 5% of patients remain normotensive. In our case, frequent blood pressure measurements showed no evidence of paroxysmal hypertension.…”

Section: Discussionmentioning

confidence: 99%

A case of pheochromocytoma associated with liver abscess and intestinal pseudo-obstruction

Okazaki-Hada

Fukuda

Nagaoka

et al. 2022

Therapeutic Advances in Endocrinology

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Pheochromocytomas can present with various symptoms. Nonspecific manifestations of pheochromocytoma include intestinal pseudo-obstruction and weight loss. Here, we present a case of pheochromocytoma in which prolonged intestinal pseudo-obstruction due to excess catecholamines was one of the factors leading to the development of a liver abscess. An 18-year-old male patient with a history of status epilepticus and severe intellectual disability was transferred to our hospital for a thorough examination of fever and constipation that had lasted for 2 months. When admitted to our hospital, he had fever, and his body mass index was 9.5 kg/m2. Upon comprehensive examination of the patient’s fever, the blood culture was found positive for Bacteroides. Computed tomography showed findings of intestinal pseudo-obstruction and a low density region in the liver that indicated a liver abscess. Imaging studies also revealed a right adrenal mass and endocrinological test showed elevated plasma norepinephrine and urine normetanephrine levels. In addition, the right adrenal mass showed uptake on 123I-metaiodobenzylguanidine scintigraphy. These findings led to a definite diagnosis of pheochromocytoma. The patient was eventually diagnosed with a pheochromocytoma coexisting with a liver abscess. After treating the liver abscess with antibiotics and ultrasound-guided drainage, an adrenalectomy was performed. The pathological findings were consistent with pheochromocytoma. Postoperatively, the catecholamine excess normalized and intestinal pseudo-obstruction and weight loss improved. We suspected that prolonged intestinal pseudo-obstruction resulted in bacterial translocation and development of a liver abscess. To the best of our knowledge, this is the first report of a pheochromocytoma associated with a liver abscess. Moreover, the clinical presentation of this patient was unusual for pheochromocytoma, as the patient did not have typical symptoms such as hypertension or tachycardia, but rather presented with constipation, intestinal pseudo-obstruction, and weight loss. This case provides valuable insight regarding the impact of catecholamine excess on the intestinal tract and body weight.

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“…Paragangliome im Thorax/Abdomen können offen und endoskopisch reseziert werden. Postoperativ können Antihypertensiva schrittweise dosisreduziert und häufig beendet werden 4 , 46 , 50 , 52 , 53 .…”

Section: Paragangliom/phäochromozytom (Ppg/pcc)unclassified

Sinnvolle Diagnose und Therapie von hormonabhängigen Hypertonusformen

et al. 2022

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ZUSAMMENFASSUNGSekundäre Hypertonieformen entstehen überwiegend durch renovaskuläre, renoparenchymatöse und endokrine Ursachen. Ein unzureichend eingestellter Blutdruck unter mindestens 3 Antihypertensiva unter Einschluss eines Diuretikums sollte auf sekundäre Ursachen abgeklärt werden. Die Diagnostik umfasst Anamnese, klinische Untersuchung, Laborscreening, Bestätigungstests, Bildgebung und ggf. selektiven Venenkatheter. Therapieoptionen sind primär die Operation und/oder medikamentöse Ansätze. Antihypertensiva können postoperativ oft reduziert werden. Nach bilateraler Adrenalektomie ist die lebenslange Hormonsubstitution erforderlich. Die endokrinologische Verlaufskontrolle und Nachsorge postoperativ sollte mindestens jährlich erfolgen. Die Zusammenarbeit zwischen Hausärzten und Ärzten der Inneren Medizin und Chirurgie mit endokriner Expertise ist notwendig. Die wichtigsten endokrinen Erkrankungen primärer Hyperaldosteronismus, Cushing-Syndrom und Paragangliom/Phäochromozytom (PGL/PCC) werden in dieser Übersicht detailliert dargestellt.

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Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas

Cited by 19 publications

References 64 publications

Undiagnosed Thyrotoxicosis Storm in a Patient Presenting With a Perioperative Sinus Tachycardia and Hypertensive Crisis After Induction of Anesthesia for Emergent Bipolar Hip Hemiarthroplasty After Traumatic Femur Neck Fracture: A Case Report

Undiagnosed Thyrotoxicosis Storm in a Patient Presenting With a Perioperative Sinus Tachycardia and Hypertensive Crisis After Induction of Anesthesia for Emergent Bipolar Hip Hemiarthroplasty After Traumatic Femur Neck Fracture: A Case Report

A case of pheochromocytoma associated with liver abscess and intestinal pseudo-obstruction

Sinnvolle Diagnose und Therapie von hormonabhängigen Hypertonusformen

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