Pheochromocytoma/Paraganglioma: Review of Perioperative Management of Blood Pressure and Update on Genetic Mutations Associated With Pheochromocytoma

Fishbein, Lauren; Orlowski, Robert; Cohen, Debbie L.

doi:10.1111/jch.12084

Cited by 67 publications

(73 citation statements)

References 46 publications

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“…17,18 While practices in preparation for surgical treatment of malignant PHEOS vary at each institution, we recognize that recent research and review articles suggest that metyrosine is ideally used in combination with alpha blockade, including either competitive or non-competitive agents. 10,11,13 Still, a review of older reports suggests that metyrosine monotherapy is a suitable option for achieving perioperative BP control in both malignant and benign PHEOS. 7 Although one case report indicated that metyrosine had not been effective as a sole agent, 15 similar reports exist for phenoxybenzamine monotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…As alternative forms of alpha-1 blockade are competitive antagonists, any catecholamine surges resulting from tumour manipulation during resection could displace the drug from the receptor and increase the risk for hypertensive crisis. 9,11 In many studies, metyrosine has been used concomitantly with alpha-1 blockade-primarily phenoxybenzamine-in the preoperative management of PHEOS. In retrospective studies, this combination of metyrosine and alpha blockade has been associated with resections that required less volume and pressure control compared with the classical method of single-agent adrenergic blockade.…”

Section: Discussionmentioning

confidence: 99%

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Failure of metyrosine therapy for preoperative management of pheochromocytoma: a case report

Thanapaalasingham

Pollmann

Schelew

2015

Can J Anesth/J Can Anesth

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Purpose Pheochromocytomas (PHEOS) are rare catecholamine-secreting adrenal tumours requiring surgical resection. Preoperative alpha-adrenergic receptor blockade to prevent intraoperative hypertension has traditionally been achieved with phenoxybenzamine. Due to changes in the availability of phenoxybenzamine in Canada, alternate therapies are needed for patients. We report our first experience using metyrosine, a tyrosine hydroxylase inhibitor, for preoperative management in a symptomatic patient with a unilateral PHEO. Clinical features A 50-yr-old male was referred to our centre with a history of symptoms suggestive of a catecholamine-secreting PHEO, including tachycardia, diaphoresis, nervousness, and tremor. Computerized tomography revealed a right adrenal mass, and additional positive imaging and elevated urine epinephrine levels supported a diagnosis of PHEO. The patient was admitted to hospital five days prior to surgery, and metyrosine therapy was initiated and titrated to 4 g daily over four days. Despite adequate blood pressure (BP) control leading up to the resection, the initial BP reading in the operating room was 191/106 mmHg, but it subsequently declined and was well controlled during induction (100-110 mmHg systolic BP). Significant hypertension (up to 201/110 mmHg) developed upon tumour manipulation and resolved with phentolamine administration and surgical isolation of the tumour. The patient's BP remained stable throughout the residual part of the procedure and in the recovery room and step-down unit. Conclusion In the case of this patient's PHEO, the use of metyrosine was unsatisfactory in achieving sufficient inhibition of catecholamine synthesis as evidenced by significant intraoperative hypertension. Metyrosine could have a role in preoperative management of these patients, but it may not be optimal as monotherapy for some patients with actively secreting tumours. RésuméObjectif Les phéochromocytomes sont des tumeurs corticosurrénaliennes rares sécrétrices de catécholamines qui nécessitent une résection chirurgicale. Le blocage préopératoire des récepteurs alpha-adrénergiques est habituellement obtenu avec de la phénoxybenzamine afin de prévenir une hypertension peropératoire. Compte tenu des modifications dans la disponibilité de la phénoxybenzamine au Canada, des traitements de substitution sont nécessaires pour les patients. Nous décrivons notre première expérience d'utilisation de la métyrosine, un inhibiteur de la tyrosine hydroxylase pour la gestion préopératoire d'un patient ayant un phéochromocytome unilatéral symptomatique.Author contributions Kabilan Thanapaalasingham coordinated the project, was responsible for data collection and analysis, drafted the manuscript, and provided critical feedback. André Pollmann assisted in the study conceptualization, coordination, and data collection aspects of the project. He was responsible for submitting the manuscript for publication. Benjamin Schelew conceptualized the study and supervised the data collection and clinical aspects of...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Failure of metyrosine therapy for preoperative management of pheochromocytoma: a case report

Thanapaalasingham

Pollmann

Schelew

2015

Can J Anesth/J Can Anesth

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“…A paragangliomák mintegy 85%-a a hasüregben található, elsősorban a juxtarenalis és paraaorticus régió-ban. A phaeochromocytomák 10-15%-a, míg a paragangliomák 30-50%-a malignus [1][2][3][4]. Jellegzetes eltérés észlelhető a hormontermelésben is.…”

Section: Esetismertetésunclassified

Ikerpárban előforduló örökletes phaeochromocytoma

Tóth¹,

Patócs

Tóth

2016

Orvosi Hetilap

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A phaeochromocytoma a katecholamin-termelő mellékvesevelő neuroendokrin sejtjeinek daganata. Az extraadrenalisan elhelyezkedő phaeochromocytomákat paragangliomának nevezzük. A phaeochromocytomák nagy része sporadikusan fordul elő, de mintegy 25-30%-uk genetikai eredetű, örökletes forma. Az örökletes phaeochromocytomaparaganglioma szindrómák incidenciája folyamatosan növekszik. Ez egyrészt az egyre szélesebb körben elterjedő genetikai vizsgálatokkal, valamint az újabb gének felfedezésével függ össze. A középkorú nőbetegnél végzett komputertomográfia során derült fény kétoldali mellékvese-nagyobbodásra. A kiegészítő képalkotó vizsgálatok, a vizeletkatecholamin-és szérum-chromogranin-A-eredmények kétoldali phaeochromocytoma jelenlétét erősítették meg. A beteg egypetéjű ikertestvérénél is hasonló, hormonálisan aktív kétoldali phaeochromocytoma igazolódott, ezért felmerült öröklődő, familiáris phaeochromocytoma lehetősége. Ennek igazolására genetikai vizsgálat történt, ami a nemrégiben felismert transzmembrán protein 127 tumorszuppresszor gén mutációját igazolta. A kivizsgálást követően mindkét betegnél mellékvese-megtartó műtétre került sor, amely során a nagyobb daganatot tartalmazó mellékvesét teljes egészében reszekálták, míg az ellenkező oldalon a mellékvese velőállományát eltávolítva mellékvese-kéregállományt hagytak vissza. A műtétet követően mindkét betegnél a vizeletkatecholamin-és szérum-chromogranin-A-szintek normalizálódtak. A mellékvesekéreg-megtartó műtét ellenére az egyik betegnél mellékvesekéreg-elégtelen-ség alakult ki, ami miatt tartós glükokortikoidpótlásra szorul. Az eset különlegességét az adja, hogy az áttekintett irodalomban és a rendelkezésre álló nemzetközi phaeochromocytoma-regiszterekben sem egypetéjű, sem kétpetéjű ikerpárról a szerzők nem találtak említést. Az egész családra kiterjesztett genetikai vizsgálat során 4 generáción keresztül sikerült igazolni a mutáns gén jelenlétét. Orv. Hetil., 2016, 157(33), 1326-1330. Kulcsszavak: örökletes phaeochromocytoma, TMEM127 génmutáció, egypetéjű ikrek Hereditary phaeochromocytoma in twinsPhaeochromocytoma is a tumor of the catecholamine-producing cells of the adrenal gland. Extraadrenal phaeochromocytomas are frequently called paragangliomas. The majority of phaeochromocytomas are sporadic, however, about 25-30% are caused by genetic mutation. These tumor are frequently referred as hereditary phaeochromocytomas/ paragangliomas. Their incidence increases continuously which can be attributed to availability of genetic examination and to the discovery of novel genes. The 47-year-old female patient underwent abdominal computed tomography which revealed bilateral adrenal gland enlargement. Abdominal magnetic resonance imaging, the 131-I-metaiodobenzylguanidine scintigraphy, urinary catecholamines and serum chomogranin A measurements confirmed the diagnosis of bilateral phaeochromocytomas. The genetically identical twin sister of the patient was also diagnosed with hormonally active bilateral phaechromocytoma, suggesting the genetic origin of phaeochro...

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“…For example, the analysis of catecholamine in blood is important for monitoring the normal and pathological activity of the adrenal gland [131,132]. The HPLC and CE quantification of catecholamine in plasma is a significant marker for some diseases such as pheochromocytoma and hypertension [133,134]. On the other hand, other central nervous system (CNS) stimulants such as caffeine and theobromine existing in tea, cocoa and coffee are also used in respiratory disorders as bronchodilators present in many pharmaceutical preparations.…”

Section: Swcnts and Mwcnts For Achiral Separation Of Pharmaceuticals mentioning

confidence: 99%

Application of Carbon Nanotubes in Chiral and Achiral Separations of Pharmaceuticals, Biologics and Chemicals

Hemasa

Naumovski

Maher

et al. 2017

Preprint

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Carbon nanotubes (CNTs) possess unique mechanical, physical, electrical and absorbability properties coupled with their nanometer dimensional scale that renders them extremely valuable for applications in many fields including nanotechnology and chromatographic separation. The aim of this review is to provide an updated overview about the applications of CNTs in chiral and achiral separations of pharmaceuticals, biologics and chemicals. Chiral SWCNTs and MWCNTs have been directly applied for the enantioseparation of pharmaceuticals and biologicals by using them as stationary or pseudostationary phases in chromatographic separation techniques such as high-performance liquid chromatography (HPLC), capillary electrophoresis (CE) and gas chromatography (GC). Achiral MWCNTs have been used for achiral separations as efficient sorbent objects in solid-phase extraction techniques of biochemicals and drugs. Achiral SWCNTs have been applied in achiral separation of biological samples. Achiral SWCNTs and MWCNTs have been also successfully used to separate achiral mixtures of pharmaceuticals and chemicals. Collectively, functionalized CNTs have been indirectly applied in separation science by enhancing the enantioseparation of different chiral selectors whereas, non-functionalized CNTs have shown efficient capabilities for chiral separations by using techniques such as encapsulation or immobilization in polymer monolithic columns.

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Pheochromocytoma/Paraganglioma: Review of Perioperative Management of Blood Pressure and Update on Genetic Mutations Associated With Pheochromocytoma

Cited by 67 publications

References 46 publications

Failure of metyrosine therapy for preoperative management of pheochromocytoma: a case report

Failure of metyrosine therapy for preoperative management of pheochromocytoma: a case report

Ikerpárban előforduló örökletes phaeochromocytoma

Application of Carbon Nanotubes in Chiral and Achiral Separations of Pharmaceuticals, Biologics and Chemicals

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