The perioperative management of children with phaeochromocytoma

Hack, Henrik

doi:10.1046/j.1460-9592.2000.00504.x

Cited by 73 publications

(60 citation statements)

References 85 publications

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“…Th erefore, pre-operative volume expansion achieved by saline infusion or increased water intake is recommended to reduce post-operative hypotension (Hack 2000;Chen et al 2010). Preoperative fl uid administration was disputed by some authors (Lentschener et al 2011).…”

Section: Preparation For Surgerymentioning

confidence: 99%

Pheochromocytoma, diagnosis and treatment: Review of the literature

Farrugia

Martikos

Tzanetis

et al. 2017

Endocrine Regulations

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Objective. We conducted an extensive review of the literature and tried to cite the most recent recommendations concerning the pheochromocytoma (PHEO).Methods. Pub Med and Google Scholar databases were searched systematically for studies concerning pheochromocytomas (intra-adrenal paragangliomas) from 1980 until 2016. Bibliographies were searched to fi nd additional articles.Results. More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. If the results are equivocal then we perform the clonidine test. If we have not done it already, we preferably do a CT scan and/or an MRI scan. Th e patient needs pre-treatment with α1-blockers at least 10-14 days before operation. Alternatives or sometimes adjuncts are Calcium Channels Blockers and/ or β-Blockers. Several familial syndromes are associated with PHEO and genetic testing should be considered.Conclusions. Th e biggest problem for pheochromocytoma is to suspect it in the fi rst place. Elevated metanephrines establish the diagnosis. With the proper preoperative preparation the risks during operation and the postoperative period are minimal. If there is a risk of the hereditable mutation, it is strongly suggested that all the patients with pheochromocytoma need clinical genetic testing.

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Section: Preparation For Surgerymentioning

confidence: 99%

Pheochromocytoma, diagnosis and treatment: Review of the literature

Farrugia

Martikos

Tzanetis

et al. 2017

Endocrine Regulations

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“…Parents must be given clear instructions to report to a physician immediately if their child develops symptoms of depression and anxiety after taking metyrosine (84).…”

Section: Special Considerationsmentioning

confidence: 99%

Preoperative Management of the Pheochromocytoma Patient

Pacák

2007

The Journal of Clinical Endocrinology &Amp; Metabolism

515

447

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A Patient's PresentationA 57-yr-old white male presented to the community hospital emergency room with a 3-wk history of presyncopal and syncopal episodes, as well as abdominal pain with intermittent nausea. The patient had reported brief feelings of light-headedness and fainting upon standing on three separate occasions before his admission. The third episode resulted in an injury to his head. At the emergency room, he also complained of abdominal pain associated with nausea.In the past, other symptoms and problems included episodes of sweating lasting 1-2 min, palpitations, and dizziness (all three usually occurring once every 1-2 wk for the past 6 months), and blurred vision for the last 2-3 months. Past medical history was also significant for labile and difficultto-control hypertension [treated with amlodipine (Norvasc) 10 mg and metoprolol (Toprol XL) 50 mg once a day] for the past 5 yr. He also had a history of severe weight gain (over 110 pounds) during the last 2 yr, compounded by low energy level. A few months before hospitalization, the patient was put on a diet and a weight loss medication (phentermine, 30 mg once a day for 2 months) resulting in a 70-pound weight loss; however, he continued to be hypertensive. In addition, he was previously diagnosed to have uncomplicated umbilical hernia, benign prostate hypertrophy, and bilateral knee osteoarthritis.At the emergency room, in view of the recurrent episodes of syncope and recent history of abdominal pain associated with nausea, a work-up for cardio-and cerebrovascular events and a possible small bowel obstruction was initiated.Computed tomography (CT) of the abdomen revealed a 6.4-cm left adrenal gland mass, in addition to a small umbilical hernia with partial small bowel obstruction. Magnetic resonance imaging confirmed the diagnosis of the left adrenal mass that appeared heterogeneous with a bright signal on T2-weighted images. It also showed moderately distended loops of the small bowel. Electrocardiogram (ECG) did not show any ischemia.The patient was taken to the operating room for urgent umbilical hernia repair. Upon induction of anesthesia, the patient developed a hypertensive crisis with a blood pressure of 250/150 mm Hg and tachycardia with a heart rate of 95 bpm. Therefore, surgery was immediately aborted. The patient was subsequently transferred to the intensive care unit, and an endocrinology consult was requested for suspicion of a possible pheochromocytoma. Biochemical evaluation for pheochromocytoma revealed elevated urine norepinephrine (NE) of 738 g/24 h (with an upper reference limit of 100 g/24 h) and epinephrine (EPI) of 779 g/24 h (upper reference limit, 24 g/24 h). Two days later, the patient underwent hernia repair with blood pressure and heart rate controlled by iv ␣-and ␤-adrenoceptor blockade. The patient was discharged on phenoxybenzamine (Dibenzyline), metoprolol, and amlodipine.Subsequently, the patient was referred to the National Institutes of Health (NIH) for further evaluation of his left adrenal pheochromocytoma. Th...

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“…Para a sua realização, deve-se iniciar uma preparação médica uma a duas semanas antes da cirurgia para minimizar os picos de liberação das catecolaminas durante a indução anestésica e a manipulação do tumor [7,25,32,42]. Não existe um algoritmo universal para essa preparação [7].…”

Section: /10unclassified

“…Não existe um algoritmo universal para essa preparação [7]. O bloqueio α 1 -adrenérgico é geralmente utilizado, sendo a fenoxibenzamina a primeira escolha na idade pediátrica [7,8,25,35,42]. Devido à possibilidade de esta causar, como efeitos secundários, taquicardia, congestão nasal e hipotensão ortostática, deve iniciar-se em doses baixas e aumentar-se progressivamente até atingir-se o controle da PA [7].…”

Section: /10unclassified

Quando hipertensão arterial persistente no adolescente tem uma origem endócrina rara: relato de dois casos e revisão da literatura

Gomes

Laranjo

Santos

et al. 2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To report two clinical cases of pheochromocytoma, a rare tumor in the pediatric population, that affects the adrenal medulla, is malignant in up to 47% of cases, and whose clinical manifestations result from hypersecretion of catecholamines. CASE DESCRIPTION: Two cases of pheochromocytoma in adolescents are described, both with persistent hypertension and one with headache, sweating, and tachycardia. Renal and adrenal ultrasound, computed tomography angiography, and measurements of catecholamines and their metabolites revealed pheochromocytoma in the left adrenal gland. Adrenalectomy was performed after pretreatment with α-blockers. Pathological examination confirmed the diagnosis. Blood pressure returned to normal in both patients after treatment. CONCLUSIONS: Pheochromocytoma has a varied and nonspecific clinical presentation, but this condition should always be considered in the differential diagnosis of high blood pressure. Early diagnosis may imply a less aggressive treatment, lower morbidity, and a lesser impact on patients' quality of life. The high likelihood of recurrence of pheochromocytoma, including as metastatic disease, requires follow-up visits for several years after its initial clinical presentation, even in the case of an apparent cure.

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The perioperative management of children with phaeochromocytoma

Cited by 73 publications

References 85 publications

Pheochromocytoma, diagnosis and treatment: Review of the literature

Pheochromocytoma, diagnosis and treatment: Review of the literature

Preoperative Management of the Pheochromocytoma Patient

Quando hipertensão arterial persistente no adolescente tem uma origem endócrina rara: relato de dois casos e revisão da literatura

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