Phaeochromocytomas presenting as acute crises after beta blockade therapy

Sibal, Latika; Jovanović, A.; Agarwal, Shivani; Peaston, R; James, Roberta; Lennard, T. W. J.; Bliss, Richard; Batchelor, Anna; Perros, Petros

doi:10.1111/j.1365-2265.2006.02571.x

Cited by 81 publications

(55 citation statements)

References 23 publications

(41 reference statements)

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“…Propranolol, atenolol, and metoprolol have been routinely used for this purpose (16,19,32). In the absence of adequate a1-blockade, b-blockade may exacerbate epinephrine-induced constriction by blocking its vasodilator component and precipitate left ventricular insufficiency (43). Cardioselective b1-adrenoreceptors should be favored (44).…”

Section: Preoperative Hypotensive Drugsmentioning

confidence: 99%

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

121

143

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Adrenalectomy for pheochromocytoma is reported with a mortality close to zero in recent studies. The dogma of preoperative fluid and hypotensive drug administrations is widely applied in patients scheduled for pheochromocytoma removal and is assumed to have a beneficial effect on operative outcomes. This paradigm is only based on historical studies of non-standardized practices and criteria for efficacy, with no control group. Pre-and intraoperative hypovolemia have never been demonstrated in patients scheduled for pheochromocytoma removal. Recent improvements in outcome of patients undergoing adrenalectomy for pheochromocytoma could also be the result of improvement in surgical techniques and refinement in anesthetic practices. Whether better knowledge of the disease, efficiency of available intravenous short-acting vasoactive drugs, and careful intraoperative handling of the tumor make it possible to omit preoperative preparation in most patients scheduled for pheochromocytoma removal is presently questionable. We reviewed available literature in this respect.

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Section: Preoperative Hypotensive Drugsmentioning

confidence: 99%

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

121

143

View full text Add to dashboard Cite

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“…Up to 10% of the patients have only minor or no signs of clinical symptoms and an increasing number of tumors are incidentally found during imaging studies (Kopetschke et al 2009). In other cases, the tumors can cause severe cardiovascular or neurological manifestations such as shock, heart failure, seizures, and stroke, which can become life threatening and also obstruct a correct diagnosis (Spencer et al 1993, Sibal et al 2006.…”

Section: Introductionmentioning

confidence: 99%

Genetics and clinical characteristics of hereditary pheochromocytomas and paragangliomas

Welander¹,

Söderkvist²,

Gimm³

2011

Endocrine-Related Cancer

309

319

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Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare neuroendocrine tumors of the adrenal glands and the sympathetic and parasympathetic paraganglia. They can occur sporadically or as a part of different hereditary tumor syndromes. About 30% of PCCs and PGLs are currently believed to be caused by germline mutations and several novel susceptibility genes have recently been discovered. The clinical presentation, including localization, malignant potential, and age of onset, varies depending on the genetic background of the tumors. By reviewing more than 1700 reported cases of hereditary PCC and PGL, a thorough summary of the genetics and clinical features of these tumors is given, both as part of the classical syndromes such as multiple endocrine neoplasia type 2 (MEN2), von Hippel-Lindau disease, neurofibromatosis type 1, and succinate dehydrogenase-related PCC-PGL and within syndromes associated with a smaller fraction of PCCs/PGLs, such as Carney triad, Carney-Stratakis syndrome, and MEN1. The review also covers the most recently discovered susceptibility genes including KIF1Bb, EGLN1/PHD2, SDHAF2, TMEM127, SDHA, and MAX, as well as a comparison with the sporadic form. Further, the latest advances in elucidating the cellular pathways involved in PCC and PGL development are discussed in detail. Finally, an algorithm for genetic testing in patients with PCC and PGL is proposed.

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“…La paciente del caso se encontraba en tratamiento exclusivo con atenolol, lo que implica un riesgo inminente de complicaciones graves como disfunción miocárdica y edema pulmonar, ya que los receptores beta adrenérgicos ubicados en la vasculatura muscular no podrán ocasionar una vasodilatación en presencia de catecolaminas, y sólo los receptores alfa adrenérgicos podrán ser estimulados, produciéndose una intensa vasoconstricción periférica y un marcado aumento de la resistencia vascular sistémica 11 .…”

Section: Discussionunclassified

Feocromocitoma: presentación como síndrome coronario agudo. Reporte de un caso

Enríquez¹,

Paredes

Tagle

et al. 2014

Rev. méd. Chile

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Refería haber presentado episodio de similares características dos días antes, lo que motivó consulta en otro servicio de urgencias, donde fue evaluada con electrocardiograma (ECG) y enzimas cardiacas; no impresionando cuadro de origen coronario, por lo que se derivó a su domicilio. Dentro de sus antecedentes destacaba historia de hipertensión arterial de data no precisada, en tratamiento con atenolol 50 mg al día, y cáncer de mama tratado 20 años antes con cirugía y radioterapia. La paciente no era fumadora ni tenía antecedentes familiares de cardiopatía coronaria.Al ingreso, la paciente se encontraba sudorosa, pero sin dolor. La presión arterial era 100/60 mmHg y su frecuencia cardiaca 87 lpm. Al examen físico destacaban yugulares colapsables en inspiración, la auscultación cardiaca no reveló soplos ni galope y había sensibilidad a la palpación epigástrica. El resto del examen no era destacable. Al interrogatorio, la paciente refería historia de episodios similares durante los últimos 6 meses, sin clara relación con esfuerzos físicos, que en un principio eran esporádicos pero que durante la última semana se hicieron más frecuentes, casi diarios. El ECG mostró un discreto supradesnivel del segmento ST (SDST) anteroseptal con inversión de la onda T de V1 a V3, que ya era evidente en ECG tomado 2 días antes y que no fue evolutivo (Figura 1). La radiografía de tórax mostró una silueta cardiaca de tamaño normal y no se observaban signos de congestión pulmonar. La paciente fue admitida a la unidad coronaria, con terapia de síndrome coronario agudo sin SDST. La troponina I de ingreso fue de 0,07 pg/ml (valor normal < 0,05) y la CK

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Phaeochromocytomas presenting as acute crises after beta blockade therapy

Cited by 81 publications

References 23 publications

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Genetics and clinical characteristics of hereditary pheochromocytomas and paragangliomas

Feocromocitoma: presentación como síndrome coronario agudo. Reporte de un caso

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