Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma

Bruynzeel, H.; Feelders, Richard A; Groenland, Theo H. N.; Meiracker, Anton H. van den; Eijck, Casper H.J. van; Lange, J. F.; Herder, Wouter W. de; Kazemier, Geert

doi:10.1210/jc.2009-1051

Cited by 206 publications

(227 citation statements)

References 23 publications

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“…There are alternative α-adrenoreceptor blockers such as: prazosin, terazosin and doxazosin. Although according to some studies they can be as effective as phenoxybenzamine, other studies did not support these conclusions (13,17). Moreover, in patients with coexisting tachyarrhythmia beta-blockers may be necessary.…”

Section: Introductionmentioning

confidence: 95%

“…The explanation of this phenomenon is on one hand high concentration of antihypertensive drugs, relatively low volume of circulating blood due to chronic vasospasm caused by catecholamines and their sudden decrease after surgery (13,48,52,53). Moreover, an association between down-regulation of alphaand beta-adrenergic receptors caused by catecholamines and postoperative hypotension was observed (54,55).…”

Section: Postoperative Managementmentioning

confidence: 99%

“…Vanillylmandelic acid, although very specific for pheochromocytoma (95%) is characterized by rather low sensitivity (65%) (12). Both the size of the tumor and degree of catecholamines production correlates strongly with intraoperative hypertension (13). It is generally accepted that every patient with suspected pheochromocytoma requires appropriate preoperative optimization with antihypertensive drugs and blood volume expansion fluids.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Section: Introductionmentioning

confidence: 95%

Section: Postoperative Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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“…Key factors are blood pressure control, adequate intravascular volume replacement, and close monitoring during surgery [18]. Because of the excessive catecholamine release during tumor manipulation and risk of hypotension from the withdrawal effect after dividing the adrenal vein, patients with pheochromocytoma are always classified as being in a high risk group.…”

Section: Discussionmentioning

confidence: 99%

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

et al. 2014

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Background: Laparoscopic adrenalectomy (LA) is the preferred approach to adrenal gland tumors. Objective: To evaluate the perioperative and functional outcomes of transperitoneal LA. Methods: We retrospectively reviewed data of all consecutive patients who underwent transperitoneal LA at our institution between April 2000 and December 2011. Results: Two hundred two patients with mean age of 46 years were included in the study. There were 109 left, 89 right, and 4 bilateral tumors. Preoperative diagnosis included 126 aldosterone-producing adenomas (APA), 33 patients with Cushing syndrome, 19 pheochromocytomas, 20 nonfunctional tumors, and 4 adrenal metastases. Mean tumor size was 3.3 cm (range 0.4-22 cm). Mean operative time was 109 min and estimated blood loss 90 mL for unilateral adrenalectomy; and 195 min and 300 mL for bilateral adrenalectomy. Four patients with pheochromocytoma required transfusion and 2 required conversion to an open approach. Seven intraoperative complications and 18 30-day postoperative complications occurred. These included 5 major complications (Clavien-Dindo grade 3-5). Ninety-seven percent of APA patients had normal serum potassium levels after surgery. Among the patients with functioning endocrine tumors, complete resolution rate from secondary hypertension was significantly higher in the pheochromocytoma group compared with those with APA or Cushing syndrome (82% vs. 48% vs. 68% respectively, p = 0.02). Mean follow up was 35.2 months. Conclusion: LA is the treatment of choice for most adrenal gland tumors with excellent outcomes and low complication rates. There was a high chance for complete resolution of secondary hypertension after surgery for pheochromocytoma.

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“…General peri-operative considerations in any patient with a pheochromocytoma, pregnant or not, include close monitoring during procedures that can induce acute catecholamine excess, such as moving the patient on the operating table, induction of anesthesia, tracheal intubation and tumor manipulation. Known risk factors for intraoperative hypertensive events include a higher preoperative plasma norepinephrine concentration, a larger maximal diameter of the tumor and a higher blood pressure before and after alphaadrenergic receptor blockade (38).…”

Section: Perioperative Managementmentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

Weerd

Noord

Loeve³

et al. 2017

European Journal of Endocrinology

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Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.

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Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma

Cited by 206 publications

References 23 publications

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

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