Pheochromocytoma Complicated With Refractory Paralytic Ileus Dramatically Improved With Intravenous Administration of Alpha-Adrenergic Receptor Antagonist, Phentolamine

Sawaki, Daigo; Otani, Yoshitaka; Sekita, Gaku; Kobayakawa, Naoshi; Fukushima, Kazuyuki; Takeuchi, Hiroaki; Aoyagi, Takaaki

doi:10.1097/00004836-200308000-00023

Cited by 14 publications

(8 citation statements)

References 3 publications

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“…The involvement of α 1 -but not α 2 -receptors in the control of motor activity in the rat ileum is of special interest, because in general not much is known about the role of α-receptors in intestinal contractility. A case report of a patient with pheochromocytoma in whom paralytic ileus was treated successfully with the α-receptor antagonist phentolamine and later with prazosin (selective α 1 -receptor agonist) 9 suggests that α-mechanisms may be involved in human small bowel contractile activity, whereas in an in vitro study in human tissue, α 2 pathways did not seem to play a role. 10 Therefore, it seems likely that in control of human small bowel contractility, α-adrenergic influence is dependent on α 1 -receptors.…”

Section: Discussionmentioning

confidence: 99%

α- and β-adrenergic receptor mechanisms in spontaneous contractile activity of rat ileal longitudinal smooth muscle

Seiler

Rickenbacher

Shaw

et al. 2005

Journal of Gastrointestinal Surgery

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Gastrointestinal motility is influenced by adrenergic modulation. Our aim was to identify specific subtypes of adrenergic receptors involved in inhibitory mechanisms that modulate gut smooth muscle contractile activity. Muscle strips of rat ileal longitudinal muscle were evaluated for spontaneous contractile activity and for equimolar dose-responses (10(-7) to 3 x 10(-5) M) to the adrenergic agents norepinephrine (nonselective agonist), phenylephrine (alpha(1)-agonist), clonidine (alpha(2)-agonist), prenalterol (beta(1)-agonist), ritodrine (beta(2)-agonist), and ZD7114 (beta(3)-agonist) in the presence and absence of tetrodotoxin (nonselective nerve blocker). Norepinephrine (3 x 10(-5) M) inhibited 65 +/- 6% (mean +/- SEM) of spontaneous contractile activity. The same molar dose of ritodrine, phenylephrine, or ZD7114 resulted in less inhibition (46 +/- 7%, 31 +/- 5%, and 39 +/- 3%, respectively; P < 0.05). The calculated molar concentration of ZD7114 needed to induce 50% inhibition was similar to that of norepinephrine, whereas higher concentrations of phenylephrine or ritodrine were required. Clonidine and prenalterol had no effect on contractile activity. Blockade of intramural neural transmission by tetrodotoxin affected the responses to ritodrine and phenylephrine (but not to norepinephrine or ZD7114), suggesting that these agents exert part of their effects via neurally mediated enteric pathways. Our results suggest that adrenergic modulation of contractile activity in the rat ileum is mediated primarily by muscular beta(3)-, beta(2)-, and alpha(1)-receptor mechanisms; the latter two also involve neural pathways.

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Section: Discussionmentioning

confidence: 99%

α- and β-adrenergic receptor mechanisms in spontaneous contractile activity of rat ileal longitudinal smooth muscle

Seiler

Rickenbacher

Shaw

et al. 2005

Journal of Gastrointestinal Surgery

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“…Patients may also present with intestinal pseudo-obstruction [92,93], abdominal distension [94], severe paralytic ileus [74,89,95,96], dilated small bowel loops [97], or megacolon [94,98]. The latter may be complicated by enterocolitis [98,99], volvulus or colonic rupture [100], and fecal peritonitis [101].…”

Section: Gastrointestinal Emergenciesmentioning

confidence: 99%

Emergencies Caused by Pheochromocytoma, Neuroblastoma, or Ganglioneuroma

Brouwers

Eisenhofer

Lenders

et al. 2006

Endocrinology and Metabolism Clinics of North America

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This article reviews emergency situations caused by diseases of the sympathetic nervous system. Pheochromocytoma is discussed first and most extensively, because there are numerous reports in the literature on patients with (unsuspected) pheochromocytoma presenting as an emergency. Two other tumors of the sympathetic nervous system are then discussed that less commonly result in endocrine emergencies: neuroblastoma and ganglioneuroma. PheochromocytomaParagangliomas are rare catecholamine-producing tumors derived from chromaffin cells that can be fatal if left undiagnosed.

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“…9 Medical options available in the management of this symptom include alpha blockade with phentolamine. 10,11 A related medication, the long-acting a receptor antagonist phenoxybenzamine, was used successfully in our patient. Metoclopramide has again been associated with worsening symptoms in this setting.…”

Section: Commentmentioning

confidence: 84%

Unique Manifestations of Catecholamine Release in Malignant Pheochromocytoma: An Experience Within an Inpatient Palliative Care Unit

Coupe

Lacey

Sanderson

2012

Journal of Pain and Symptom Management

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Malignant pheochromocytoma is a rare disorder. We describe the case of a 41-year-old female with disseminated metastatic pheochromocytoma who was admitted for ongoing palliative and supportive care within an inpatient palliative care unit. Predominant symptoms included severe gastrointestinal pseudo-obstruction and orthostatic hypotension Pseudo-obstruction management included percutaneous enterogastric and percutaneous enterojejunostomy tubes for gastric decompression and delivery of nutrition, respectively. Debilitating symptoms of orthostatic hypotension were mitigated with judicious fluid balance and appropriate use of adrenergic blocking agents. The potential for metoclopramide to worsen symptoms also was a significant component of management. The case presents rare features of this unusual disease and is unique for its setting within the confines of a palliative care unit.

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Pheochromocytoma Complicated With Refractory Paralytic Ileus Dramatically Improved With Intravenous Administration of Alpha-Adrenergic Receptor Antagonist, Phentolamine

Cited by 14 publications

References 3 publications

α- and β-adrenergic receptor mechanisms in spontaneous contractile activity of rat ileal longitudinal smooth muscle

α- and β-adrenergic receptor mechanisms in spontaneous contractile activity of rat ileal longitudinal smooth muscle

Emergencies Caused by Pheochromocytoma, Neuroblastoma, or Ganglioneuroma

Unique Manifestations of Catecholamine Release in Malignant Pheochromocytoma: An Experience Within an Inpatient Palliative Care Unit

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