Pheochromocytoma multisystem crisis successfully treated by emergency surgery: Report of a case

Uchida, Naotaka; Ishiguro, Kiyosuke; Suda, Takako; Nishimura, Motonobu

doi:10.1007/s00595-009-4165-8

Cited by 31 publications

(25 citation statements)

References 14 publications

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“…Application of α -adrenergic blockers resulted in prompt and sustained relief of all symptoms, thus confirming the crucial role of α -adrenergic mechanisms in the development of this type of PE [6]. α -Adrenergic blockers have also been applied in the treatment of pheochromocytoma multisystem crisis [13]. Pathogenesis of PE in patients with pheochromocytoma is thought to be similar to NPE, which is believed to result from massive α -adrenergic stimulation caused by a discharge of sympathetic activity [6–8].…”

Section: Catecholamine-associated Pulmonary Edema In Clinical Condmentioning

confidence: 90%

“…Both in patients with pheochromocytoma and with NPE, edema formation was mainly associated with α -adrenoceptor stimulation, and consequently, treatment with α -adrenergic antagonists was effective with respect to edema resolution [6, 13, 33, 34]. Several cases of PE following intraoperative topical application of PHE have been reported [58, 59].…”

Section: Effects Of β-Adrenergic Stimulationmentioning

confidence: 99%

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Contribution ofα- andβ-Adrenergic Mechanisms to the Development of Pulmonary Edema

Raßler

2012

Scientifica

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Endogenous or exogenous catecholamines can induce pulmonary edema (PE). This may occur in human pathologic conditions such as in pheochromocytoma or in neurogenic pulmonary edema (NPE) but can also be provoked after experimental administration of adrenergic agonists. PE can result from stimulation with different types of adrenergic stimulation. With α-adrenergic treatment, it develops more rapidly, is more severe with abundant protein-rich fluid in the alveolar space, and is accompanied by strong generalized inflammation in the lung. Similar detrimental effects of α-adrenergic stimulation have repeatedly been described and are considered to play a pivotal role in NPE or in PE in patients with pheochromocytoma. Although β-adrenergic agonists have often been reported to prevent or attenuate PE by enhancing alveolar fluid clearance, PE may also be induced by β-adrenergic treatment as can be observed in tocolysis. In experimental models, infusion of β-adrenergic agonists induces less severe PE than α-adrenergic stimulation. The present paper addresses the current understanding of the possible contribution of α- and β-adrenergic pathways to the development of PE.

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Section: Catecholamine-associated Pulmonary Edema In Clinical Condmentioning

confidence: 90%

Section: Effects Of β-Adrenergic Stimulationmentioning

confidence: 99%

Contribution ofα- andβ-Adrenergic Mechanisms to the Development of Pulmonary Edema

Raßler

2012

Scientifica

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“…Gastrointestinal manifestations include paralytic ileus and intestinal ischemia secondary to vasoconstriction. Vascular complications can include peripheral thrombosis, embolism and vasospasm [5,6].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The patient eventually recovered from his multisystem organ failure and discharged from the hospital 1 month later. In 2010, a reported case of PMC was described that initially presented with acute respiratory failure and encephalopathy, in which surgical resection was performed 11 days after admission because of the patient's progressive and uncontrollable medical deterioration [5]. Post-operatively, the patient's condition improved almost immediately, and the multisystem organ failure resolved except for chronic renal failure requiring long-term haemodialysis.…”

Section: Initial Management: When Is It Appropriate To Operate?mentioning

confidence: 99%

Pheochromocytoma Crisis

Castelino¹,

Mitmaker²

2017

Clinical Management of Adrenal Tumors

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Pheochromocytomas are rare tumours of the adrenal gland that secrete catecholamines. The classical presentation of these tumours consists of a clinical triad of headaches, palpitations and diaphoresis. This clinical presentation should not be confused with the potentially fatal presentation of pheochromocytoma crisis, which may include severe haemodynamic instability and collapse, multi-organ failure, hyperthermia and encephalopathy. When patients present in profound shock, supportive care and treatment are initiated. Patients presenting with pheochromocytoma crisis have an underlying adrenal tumour, but the clinical manifestations of this life-threatening condition can mimic other entities. Once diagnosis is made, previous anecdotal evidence has shown that pheochromocytoma crisis is a surgical emergency. However, retrospective study of a larger sample of patients presenting with pheochromocytoma crisis suggests that medical management in the acute setting is appropriate and safe. The ultimate treatment is indeed surgical; however, there is no clear recommendation for the acute management of pheochromocytoma crisis. This chapter will focus on the medical and surgical management of potentially life-threatening pheochromocytoma crisis. An in-depth review of the clinical presentation, pathophysiology, causes and treatments of pheochromocytoma crisis will be provided, including the controversial areas surrounding decision-making and timing for adrenalectomy.

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“…9 Az acut phaeochromocytomás krízisben végzett adrenalectomiával kapcsolatban az irodalmi háttér szegényes és helyenként ellentmondó. [10][11][12][13] Esetünkben a beteg állapota intenzív terápiával már nem volt stabilizálható, ezért a sürgős sebészi megoldást választottuk. Körültekintő perioperativ előkészí-téssel és gondos anaesthesiával a daganat eltávolításra került.…”

Section: Következtetésunclassified

Phaeochromocytomás krízisben végzett acut laparoscopos adrenalectomia

Bereczky

Madách

Gál

et al. 2014

MaSeb

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Esetismertetés: A szerzők egy 30 éves nőbeteg esetét mutatják be, akinek intenzív osztályos felvételére hypertoniás krízist kísérő mellkasi panaszok, cardialis decompensatio, progrediáló acut légzési elégtelenség és tudatzavar miatt került sor. A gyors kivizsgálás mellett azonnal megkezdett intenzív terápia ellenére a felvételt követő harmadik napra többszervi elégtelenség képe alakult ki. Miután a kórkép kialakulása a bal oldali mellékvese térfoglaló folyamatára volt visszavezethető, a multidiszciplináris konzílium acut laparoscopos adrenalectomia végzése mellett foglalt állást. Az eltávolított képlet szövettani diagnózisa phaeochromocytoma volt. A postoperativ időszakban a beteg állapota fokozatosan javult, tünetei, panaszai regrediáltak, majd gyógyultan távozott. Megbeszélés: A phaeochromocytoma diagnózisa nehéz feladat, az általa kiváltott tünetek és panaszok sok egyéb kórképre is utalhatnak. Az acut phaeochromocytomás krízis általában belgyógyászati, intenzív terápiás eszközökkel uralható. A súlyos, többszervi elégtelenséghez vezető esetekben indokolt az acut műtéti beavatkozás. Az ilyen beavatkozások rizikója igen magas, de korrekt intra-és postoperativ ész-leléssel, megfelelő intenzív terápiával a laparoscopos műtét ezekben az esetekben választható megoldás lehet. Kulcsszavak: phaeochromocytoma, phaeochromocytomás krízis, urgens laparoscopos adrenalectomiaCase report: Authors present the case of a 30-year-old female patient, who was admitted to the ICU because of hypertensive crisis accompanied by chest complains, cardiac decompensation, progrediating short of breath and unconsciousness. Despite the quick examinations and the prompt treatment multi-organ failure developed 3 days after admission. Investigations revealed the underlying cause, which was a left-sided suprarenal neoplasm. Hence, multidisciplinary decision was made to carry out a laparoscopic adrenalectomy urgently. The histology examination of the removed neoplasm was pheochromocytoma. In the postoperative period the condition of the patient gradually improved, her symptoms and complains settled, and fi nally she was discharged in a healthy condition. Discussion: The diagnosis of a pheochromocytoma is a diffi cult task, the symptoms and complains caused by it can simulate many other illnesses. The acute crisis caused by pheochromocytoma usually can be treated conservatively, but in more severe cases with impending multi-organ failure an urgent operative treatment can be unavoidable. Though the operative risk is relatively high, the correct intra-and postoperative treatment with a quick laparoscopic procedure can be effective. Keywords BevezetésA phaeochromocytoma a mellékvesevelő (80-85%) vagy az extraadrenalis (15-20%) paraganglionok chromaffi nsejtjeinek daganata. Hypertoniás betegeknél a phaeochromocytoma prevalenciája 0,1-0,6%. A mellékvese-incidentalo-

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Pheochromocytoma multisystem crisis successfully treated by emergency surgery: Report of a case

Cited by 31 publications

References 14 publications

Contribution ofα- andβ-Adrenergic Mechanisms to the Development of Pulmonary Edema

Contribution ofα- andβ-Adrenergic Mechanisms to the Development of Pulmonary Edema

Pheochromocytoma Crisis

Phaeochromocytomás krízisben végzett acut laparoscopos adrenalectomia

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