Table of Contents
1
UI - 11403350
AU - Gardet V; Gatta B; Simonnet G; Tabarin A; Chene G; Ducassou D; Corcuff
TI -
JB
Lessons from an unpleasant surprise: a biochemical strategy for the
diagnosis of pheochromocytoma.
SO - J Hypertens 2001 Jun;19(6):1029-35
AD - Department of Nuclear Medicine, Centre Hospitalier Universitaire de
Bordeaux, Pessac, France.
OBJECTIVE: To audit the performances of the analytes used in the
diagnosis of pheochromocytoma and to present a graphical guideline to
help the diagnosis. DESIGN: A 5 year retrospective study. SETTINGS:
Laboratory and departments of a university hospital. PARTICIPANTS:
In-patients, suspected of bearing a pheochromocytoma, were investigated
for urinary metanephrines and catecholamines (photometric method) and
vanillylmandelic acid, fractionated catecholamines and metanephrines
[high pressure liquid chromatography (HPLC) coupled to electrochemical
detection (ED)] urinary excretion. MAIN OUTCOME: Patients with a
pheochromocytoma (24 out of 2003 patients) were diagnosed by the
combination of normetanephrine and metanephrine determination. RESULTS:
All analytes but dopamine were significantly elevated in patients with a
pheochromocytoma. The area under the receiver operating characteristics
(ROC) curves were the highest for total metanephrines, normetanephrine
and metanephrine determinations. Because of analytical interferences in
the metanephrines determination, the normetanephrine and metanephrine
performed better. It is noteworthy that all pheochromocytomas had either
normetanephrine or metanephrine levels above their respective optimal
threshold (sensitivity 100%). The best optimal threshold performance was
reached by the mean of three daily samples. Total or fractionated
catecholamines or vanillylmandelic acid were less accurate tools.
CONCLUSION: Amongst urinary tests, the combined use of HPLC/ED
determination of normetanephrine and metanephrine seems the most
effective screening strategy for the diagnosis of pheochromocytoma. The
older total metanephrine photometric assay is grieved by analytical
interferences.
2
UI - 11440275
AU - Letizia C; De Toma G; Caliumi C; Cerci S; Massa R; Loria RD; Alo P;
TI -
Marinoni EM; Diacinti D; D'Erasmo E
Plasma adrenomedullin concentrations in patients with adrenal
pheochromocytoma.
SO - Horm Metab Res 2001 May;33(5):290-4
AD - Department of Clinical Science, University La Sapienza, Rome, Italy.
claudioletizia@uniroma1.it
BACKGROUND: The hypotensive peptide adrenomedullin was first isolated in
extracts of human pheochromocytoma. There is, however, no information
available on the behaviour of circulating adrenomedullin or on the
correlation with catecholamines in patients with pheochromocytoma.
OBJECTIVES: 1) to investigate whether plasma adrenomedullin levels were
changed in 10 patients with pheochromocytoma when compared to 21 healthy
subjects and 16 patients with essential hypertension; 2) to determine
whether or not adrenomedullin has a counter-regulatory role in
catecholamine excess in pheochromocytoma or is responsible for
hemodynamic modifications before and after tumour resection; 3) to
determine tissue distribution of iradrenomedullin in the
pheochromocytoma. METHODS: Plasma adrenomedullin and catecholamine
levels were measured in all patients with pheochromocytoma before and
four weeks after tumour removal. In the four patients undergoing
resection of tumours, plasma levels of adrenomedullin were measured at
different time-points during surgery. RESULTS: The mean plasma
adrenomedullin concentrations ( SD) in patients with pheochromocytoma
(37.9 +/- 6pg/ml) were significantly higher (p<0.0001) than those in
normal subjects (13.7 +/- 6.1 pg/mI) and patients with essential
hypertension (22.5 +/- 9.lpg/ml). Adrenomedullin levels correlated with
plasma noradrenaline (r = 0.516, p = 0.0124). In all patients with
pheochromocytoma, plasma adrenomedullin concentrations decreased after
removal of tumours (from 37.9 +/- 6 to 10.9 +/- 4.6 pg/ml; p < 0.0001).
In the four patients studied during surgery, baseline plasma
adrenomedullin and noradrenaline levels were markedly elevated, and
increased significantly with tumour manipulation, decreasing 24 hours
after operation. Adrenal medulla cells surrounding the pheochromocytoma
site stained for ir-adrenomedullin, whereas only isolated cells of
pheochromocytoma stained for the peptide. CONCLUSIONS: This study
demonstrates that circulating adrenomedullin is increased in
pheochromocytoma, and is also correlated with plasma noradrenaline
levels. Adrenomedullin may represent an additional biochemical parameter
for clinical monitoring of patients with pheochromocytoma.
3
UI - 11443849
AU - Gimm O
TI -
Multiple endocrine neoplasia type 2: clinical aspects.
SO - Front Horm Res 2001;28():103-30
AD - Department of General Surgery, Martin-Luther-University,
Halle-Wittenberg, Germany. oliver.gimm@medizin.uni-halle.de
4
UI - 11444194
AU - Garcia-Escudero A; de Miguel-Rodriguez M; Moreno-Fernandez A;
TI -
Navarro-Bustos G; Galera-Ruiz H; Galera-Davidson H
Prognostic value of DNA flow cytometry in sympathoadrenal
paragangliomas.
SO - Anal Quant Cytol Histol 2001 Jun;23(3):238-44
AD - Department of Pathology, University Hospital Virgen Macarena, Seville,
Spain.
OBJECTIVE: To determine whether ploidy patterns are related to prognosis
in sympathoadrenal paragangliomas (SAP) using flow cytometry. STUDY
DESIGN: DNA flow cytometric analysis of formalin-fixed,
paraffin-embedded tumor samples from 36 patients with SAP was performed.
Eight cases fulfilled at least one of the following malignancy criteria:
(1) extensive invasion of adjacent structures (5 cases), (2) local
recurrence (3 cases), or (3) metastases (4 cases). RESULTS: Of the 36
tumors, 22 (61%) showed nondiploid patterns (12 aneuploid, 10
tetraploid). All diploid tumors were benign, while all malignant cases
showed nondiploid patterns (P = .0131). The differences between diploid
and aneuploid tumors and between diploid and tetraploid tumors, with
regard to the malignancy of the disease, were statistically significant
(P = .03311 and .01976, respectively). Only one malignant tumor had a
DNA index < 1.75 (P = .00259). CONCLUSION: Anomalous DNA ploidy patterns
are frequent in SAP, without necessarily implying malignancy. However,
diploid DNA content may be a marker of a good prognosis. The likelihood
of malignancy is greater in the tetraploid and peritetraploid range.
5
UI - 11465661
AU - Diamond JA
TI -
Pheochromocytoma in a symptomatic patient with severe hypertension upon
anesthesia induction.
SO - Am J Hypertens 2001 Jul;14(7 Pt 1):729-30
AD - Mount Sinai School of Medicine, New York, New York 10029, USA.
6
UI - 11456261
AU - Glodny B; Winde G; Herwig R; Meier A; Kuhle C; Cromme S; Vetter H
TI -
Clinical differences between benign and malignant pheochromocytomas.
SO - Endocr J 2001 Apr;48(2):151-9
AD - Institute of Pharmaceutical Biology and Phytochemistry, Westfalische
Wilhelms-Universitat Munster, Germany.
Most pheochromocytomas can be cured by resection. In view of the
unfavourable prognosis for surgical therapy in cases of late tumour
detection and malignant tumours, the aim of the present study is to
differentiate between typical signs and symptoms of malignant versus
benign pheochromocytomas. We investigated the records of 133 patients
retrospectively (1967-1998). In cases of benign tumours (104 of 133,
mean age 42+/-15.8 years) tumour size was 5.9+/-3.4 cm, and history was
47.4+/-75.4 months. 7.7% of the tumours were extraadrenal, and 77% had
paroxysmal manifestations. The other 29 patients (mean age: 39.2+/-21.9
years) had malignant lesions (tumour size: 9.4+/-5.9 cm (p=0.0022);
history: 7.4+/-5.6 months (p=0.0137); extraadrenal: 24.1% (p=0.0219);
paroxysmal: 37.9% (p=0.0012)). Symptoms of patients with benign tumours
were hypertension (80%), headaches (42.3%), sweating (30.8%),
tachycardia (26%) and pallor (24%) (Malignant: Hypertension 46%,
p=0.0873; headaches 11%, p=0.0008; sweating 11%, p=0.0196; tachycardia
14%, p=0.1961 and pallor 0%, p=0.0010). Abdominal pain and dorsalgia
occurred more frequently in malignant pheochromocytomas (26% versus 7%,
p=0.0014). Unusually short histories and extraadrenal localization
appear to be suspicious for malignancy. The "typical" clinical signs and
symptoms occur more frequently in patients with benign tumours and can
therefore be regarded as typical signs of benign pheochromocytomas.
7
UI - 11475579
AU - Frenzel S; Apel TW; Heidemann PH; Zerres K; Neumann HP; Dorr HG
TI -
Phaeochromocytoma associated with a de novo VHL mutation as form fruste
of von Hippel-Lindau disease.
SO - Eur J Pediatr 2001 Jul;160(7):421-4
AD - Division of Paediatric Endocrinology, University Hospital for Children
and Adolescents, Loschgestrasse 15, 91054 Erlangen, Germany.
HGDoerr@kinder.imed.uni-erlangen.de
Phaeochromocytomas usually occur sporadically but may be associated with
dominant inherited cancer syndromes such as multiple endocrine neoplasia
type 2 (MEN 2), von Hippel-Lindau disease (VHL) and type 1
neurofibromatosis. We report on a boy presenting at age 8 years with an
isolated benign phaeochromocytoma of the left adrenal. Three years later
a second adrenal phaeochromocytoma was diagnosed on the right side and
removed. His family history was negative. Genetic analysis did not show
a mutation in the MEN 2 susceptible proto-oncogene rearranged during
transfection; however, we found a germline missense mutation in the VHL
gene (nucleotide 695 G to A transversion) which has been described only
twice before in the literature. Both parents had normal (wild type) VHL
copies indicating that our patient had a de novo germline VHL mutation.
Careful clinical evaluation of the patient at 18 years did not reveal
any other manifestations of VHL disease. CONCLUSION: Carriers of von
Hippel-Lindau germline mutations can present with a form fruste of von
Hippel-Lindau disease presenting initially with unilateral
phaeochromocytoma and therefore mutation analysis should be carried out.
8
UI - 11573274
AU - Yoshida K; Tatsukawa H; Ashida K; Matsubara K; Kubota Y; Uwatoko H;
TI -
Ogasawara H; Katsuma Y; Kitamura K
[Pheochromocytoma with severe paralytic ileus occurred from acute
pulmonary edema caused by metoclopramide]
SO - Nippon Naika Gakkai Zasshi 2001 Aug 10;90(8):1522-4
AD - Department of Internal Medicine, Kyoto City Hospital, Kyoto.
9
UI - 11547079
AU - Anderson MI; O'Reilly KJ; Costabile RA
TI -
Retroperitoneal bronchogenic cyst mimicking a pheochromocytoma.
SO - J Urol 2001 Oct;166(4):1379-80
AD - Urology Service, Department of Surgery, Madigan Army Medical Center, Ft.
Lewis, Washington, USA.
10
UI - 11560309
AU - Godfrey JA; Rickman OB; Williams AW; Thompson GB; Young WF Jr
TI -
Pheochromocytoma in a patient with end-stage renal disease.
SO - Mayo Clin Proc 2001 Sep;76(9):953-7
AD - Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905,
USA.
Pheochromocytoma is a rare tumor. To our knowledge only 15 cases have
been reported in patients with end-stage renal disease (ESRD). We
describe a 46-year-old woman with ESRD and a history of paroxysmal and
difficult-to-control hypertension. During anesthesia for a surgical
procedure, the patient experienced blood pressure lability with systolic
blood pressures ranging from 76 to 360 mm Hg. Serum catecholamine
concentrations were 2,698 pg/ mL (reference value, <750 pg/mL) for
norepinephrine, 33 pg/mL (<110 pg/mL) for epinephrine, and 55 pg/mL (<30
pg/mL) for dopamine. The concentrations of plasma metanephrines were
6.84 nmol/L (<0.50 nmol/L) for metanephrine and 14.64 nmol/L (<0.90
nmol/L) for normetanephrine. Abdominal computed tomography showed a
right-sided, 4-cm mass posterior to the infrahepatic inferior vena cava.
Following blood pressure control with alpha- and beta-adrenergic
blockade, the mass was removed. Pathologic examination demonstrated the
mass was a pheochromocytoma. The maximum postoperative systolic blood
pressure was 160 mm Hg. Postoperative plasma normetanephrine
concentration was 2.80 nmol/L, and metanephrine was obscured by
interfering substances. This case report and literature review
emphasizes the difficulty in diagnosing pheochromocytomas in patients
with ESRD despite the myriad of available diagnostic tests.
11
UI - 11569997
AU - Wijeyaratne CN; Sheriffdeen AH; Seneviratne HR
TI -
Bilateral phaeochromocytoma during pregnancy.
SO - Ceylon Med J 2001 Mar;46(1):24-6
12
UI - 11575354
AU - Atallah F; Bastide-Heulin T; Soulie M; Crouzil F; Galiana A; Samii K;
TI -
Virenque C
Haemodynamic changes during retroperitoneoscopic adrenalectomy for
phaeochromocytoma.
SO - Br J Anaesth 2001 May;86(5):731-3
AD - Department of Anaesthesiology, Rangueil Hospital, Toulouse University
Hospitals, France.
Surgical removal of phaeochromocytoma may be accompanied by acute
cardiovascular changes. We report the haemodynamic changes in seven
patients with retroperitoneal laparoscopic adrenalectomy for
phaeochromocytoma. Transient hypertension (systolic pressure (SBP) > 160
mm Hg) was observed in all patients during manipulation of the tumour,
in two patients during pneumoretroperitoneum insufflation, and in one
patient during intubation. Small doses of nicardipine were sufficient to
control these episodes of hypertension. Transient hypotension (SBP < 100
mm Hg) was observed in two patients during exsufflation and in one
patient during repositioning to the lateral position. Our observations
suggest that this approach provides relative haemodynamic stability,
especially during pneumoretroperitoneum insufflation.
13
UI - 11574094
AU - Baughan J; de Gara C; Morrish D
TI -
A rare association between acromegaly and pheochromocytoma.
SO - Am J Surg 2001 Aug;182(2):185-7
AD - Department of Surgery, Division of General Surgery, University of
Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.
The occurrence of multiple endocrine tumors is rare; however, they may
be found with hereditary diseases such as multiple endocrine neoplasia
(MEN). The endocrine tumors involved with these diseases are well
documented. We present a case of a patient with a pheochromocytoma and a
growth hormone (GH) secreting pituitary adenoma. This association is not
described with any of the known MEN syndromes. The association may be a
cross-over MEN syndrome or a secondarily induced GH-secreting pituitary
adenoma from a pheochromocytoma producing growth hormone releasing
hormone (GHRH) instead of catecholamines.
14
UI - 11584528
AU - Fuessl HS
TI -
[Secondary hypertension, 4: Pheochromocytoma as etiology of
hypertension]
SO - MMW Fortschr Med 2001 Sep 6;143(35-36):39-40
AD - Ltd. Arzt Innere Abt., Bezirkskrankenhaus Haar, Ringstr. 33a, D-85540
Haar. HFuessl@compuserve.com
15
UI - 11606344
AU - Poopalalingam R; Chin EY
TI -
Rapid preparation of a patient with pheochromocytoma with labetolol and
magnesium sulfate.
SO - Can J Anaesth 2001 Oct;48(9):876-80
AD - Department of Anaesthesia and Surgical Intensive Care, Singapore General
Hospital, Singapore. rumini@singnet.com.sg
PURPOSE: To describe the rapid perioperative optimization and control of
blood pressure in a young patient who presented with pheochromocytoma.
He was non-compliant with phenoxybenzamine but insisted on early
surgery. He was scheduled for laparoscopic resection of the tumour.
CLINICAL FEATURES: This 32-yr-old man presented with uncontrolled
hypertension for a few years for which he was treated with nifedipine.
He subsequently defaulted follow-up. The patient presented again
approximately three months from the day of surgery and was diagnosed to
have a pheochromocytoma. The endocrinologist prescribed phenoxybenzamine
and propanolol in addition to the nifedipine but the patient stopped
taking both drugs six weeks prior to surgery due to their side effects.
The patient was admitted the evening before surgery to the intensive
care unit for rapid control of his blood pressure. Blood pressure was
optimized with an infusion of labetolol and volume expansion titrated
under central venous catheter and intraarterial blood pressure guidance
throughout the night. On the morning of surgery, a magnesium sulfate
infusion was started. The laparoscopic surgery proceeded uneventfully
and the patient was hemodynamically stable. There were two transient
periods of hypotension after induction and at removal of tumour
respectively which were corrected with a brief adrenaline infusion. No
adverse outcome was noted. CONCLUSION: This case highlights the
possibility of a more rapid perioperative control of pheochromocytoma
using high doses of labetolol and a magnesium sulfate infusion to
achieve stable intraoperative hemodynamics during laparoscopic resection
of pheochromocytoma.
16
UI - 11684959
AU - Salmenkivi K; Haglund C; Arola J; Heikkila P
TI -
Increased expression of tenascin in pheochromocytomas correlates with
malignancy.
SO - Am J Surg Pathol 2001 Nov;25(11):1419-23
AD - Department of Pathology, Haartman Institute, University of Helsinki and
HUCH Laboratory Diagnostics, Helsinki University Central Hospital,
Helsinki, Finland. kaisa.salmenkivi@helsinki.fi
Tenascin is a significant extracellular matrix glycoprotein, which is
upregulated in various neoplasias and pathologic processes.
Pheochromocytomas are rare tumors of the sympathoadrenal system, whose
malignancy is almost impossible to predict. There are no histologic or
chemical markers available that would define the malignant behavior of
these tumors, except the discovery of metastases. In our search for new
markers, we investigated the immunohistochemical expression of tenascin
in a large number of pheochromocytomas and paragangliomas. Seven tumors
were metastasized and were thus considered malignant. Normal adrenal
medulla was tenascin negative. A striking difference was seen between
malignant and benign pheochromocytomas. All malignant pheochromocytomas
expressed stromal tenascin strongly or moderately, whereas most benign
pheochromocytomas (28 of 37, 70%) showed no or only weak
immunopositivity. The staining was strong or moderate also in 13 of 28
(46%) of the tumors that showed histologically suspicious features, here
called borderline tumors. Paragangliomas showed a more heterogeneous
staining pattern, and no significant difference was found between benign
and malignant paragangliomas. To our knowledge, this is the first study
to demonstrate the expression of tenascin in pheochromocytomas and
particularly the enhanced expression in malignant pheochromocytomas. We
therefore suggest that tenascin may be associated with the malignant
transformation and metastasis of pheochromocytomas. It is also a
potential marker predicting more aggressive behavior in
pheochromocytomas.
17
UI - 11693208
AU - O'Halloran T; McGreal G; McDermott E; O'Higgins N
TI -
47 years of phaeochromocytomas.
SO - Ir Med J 2001 Jul-Aug;94(7):200-3
AD - Department of Surgery, St. Vincent's Hospital, Dublin.
Thirty three patients with phaeochromocytomas had surgery in St.
Vincent's Hospital between 1950 and 1997. 32 patients had hypertension,
32 had palpitations and 30 had excessive sweating. All patients had at
least one of these cardinal symptoms. Diagnostic tests changed over this
period. In the early cases the phentolamine test was used, later
diagnosis was confirmed by measurement of urinary VMA and
catecholamines. IVP, CT, ultrasound or MIBG scanning were used to locate
the tumours. Before 1967, 3 of 17 patients died peri-operatively, 2 of
these from strokes and one from pulmonary embolism. Since then, all
patients have survived surgery. Four of the women had phaeochromocytomas
diagnosed during pregnancy. Two of the 33 patients had tumours that were
malignant, the remainder being benign. One patient has died from
metastatic disease. This series illustrates the changing trends in the
surgical management of phaeochromocytomas.
18
UI - 11709729
AU - Astuti D; Agathanggelou A; Honorio S; Dallol A; Martinsson T; Kogner P;
TI -
Cummins C; Neumann HP; Voutilainen R; Dahia P; Eng C; Maher ER; Latif F
RASSF1A promoter region CpG island hypermethylation in
phaeochromocytomas and neuroblastoma tumours.
SO - Oncogene 2001 Nov 8;20(51):7573-7
AD - Section of Medical and Molecular Genetics, Department of Paediatrics and
Child Health, University of Birmingham, The Medical School, Edgbaston,
Birmingham, B15 2TT, UK.
Deletions of chromosome 3p are frequent in many types of neoplasia
including neural crest tumours such as neuroblastoma (NB) and
phaeochromocytoma. Recently we isolated several candidate tumour
suppressor genes (TSGs) from a 120 kb critical interval at 3p21.3
defined by overlapping homozygous deletions in lung and breast tumour
lines. Although mutation analysis of candidate TSGs in lung and breast
cancers revealed only rare mutations, expression of one of the genes
(RASSF1A) was absent in the majority of lung tumour cell lines analysed.
Subsequently methylation of a CpG island in the promoter region of
RASSF1A was demonstrated in a majority of small cell lung carcinomas and
to a lesser extent in non-small cell lung carcinomas. To investigate the
role of 3p TSGs in neural crest tumours, we (a) analysed
phaeochromocytomas for 3p allele loss (n=41) and RASSF1A methylation
(n=23) and (b) investigated 67 neuroblastomas for RASSF1A inactivation.
46% of phaeochromocytomas showed 3p allele loss (38.5% at 3p21.3).
RASSF1A promoter region hypermethylation was found in 22% (5/23) of
sporadic phaeochromocytomas and in 55% (37/67) of neuroblastomas
analysed but RASSF1A mutations were not identified. In two neuroblastoma
cell lines, methylation of RASSF1A correlated with loss of RASSF1A
expression and RASSF1A expression was restored after treatment with the
demethylating agent 5-azacytidine. As frequent methylation of the CASP8
gene has also been reported in neuroblastoma, we investigated whether
RASSF1A and CASP8 methylation were independent or related events. CASP8
methylation was detected in 56% of neuroblastomas with RASSF1A
methylation and 17% without RASSF1A methylation (P=0.0031). These
results indicate that (a) RASSF1A inactivation by hypermethylation is a
frequent event in neural crest tumorigenesis, particularly
neuroblastoma, and that RASSF1A is a candidate 3p21.3 neuroblastoma TSG
and (b) a subset of neuroblastomas may be characterized by a CpG island
methylator phenotype.
19
UI - 11701743
AU - Salmenkivi K; Haglund C; Ristimaki A; Arola J; Heikkila P
TI -
Increased expression of cyclooxygenase-2 in malignant pheochromocytomas.
SO - J Clin Endocrinol Metab 2001 Nov;86(11):5615-9
AD - Department of Pathology, Haartman Institute, University of Helsinki and
HUCH Laboratory Diagnostics, Helsinki University Central Hospital,
FIN-00014 Helsinki, Finland. kasai.salmenkivi@helsinki.fi
Pheochromocytomas are rare tumors of the adrenal medulla or the
paraganglion system. There are no histological or chemical markers
available that define the malignant behavior of these tumors; so far
only the discovery of metastases reveals malignancy. Cyclooxygenase
(Cox) is the key enzyme in conversion of arachidonic acid to PGs, and
two isoforms, Cox-1 and Cox-2, have been identified. Cox-2 has been
associated with carcinogenesis, and it is overexpressed in many human
malignancies. We have now investigated the expression of Cox-2 in normal
adrenal gland, in 92 primary pheochromocytomas and in six metastases
using immunohistochemistry and Northern blot and Western blot analyses.
Cox-2 protein was expressed in the adrenal cortex, whereas the medulla
was negative as detected by immunohistochemistry. Interestingly, all
malignant pheochromocytomas (n = 8), regardless of the primary location
of the tumor, showed moderate or strong Cox-2 immunoreactivity, whereas
75% of the benign adrenal tumors (n = 36) showed no or only weak
immunopositivity. The staining was negative or weak in 79% of the
adrenal tumors that showed histologically suspicious features (n = 24),
but had not metastasized. Most of the pheochromocytoma samples studied
also expressed low levels of Cox-2 mRNA. Our data show that normal
adrenal medulla does not express Cox-2 immunohistochemically. However,
strong Cox-2 protein expression was found in malignant
pheochromocytomas, whereas most benign tumors expressed Cox-2 only
weakly. To our knowledge, this is the first report on Cox-2 expression
in pheochromocytomas and enhanced expression in malignant
pheochromocytomas. These findings suggest that negative or weak Cox-2
expression in pheochromocytomas favors benign diagnosis.
20
UI - 11714015
AU - Sotunmbi PT; Shittu OB; Windokun A; Eyelade OA
TI -
Combined general and epidural anaesthesia for excision of
phaeochromocytoma--a unique and safe technique.
SO - Afr J Med Med Sci 2000 Sep-Dec;29(3-4):319-22
AD - Department of Anesthesia, University College Hospital, Ibadan, Nigeria.
Surgical excision of phaeochromocytoma is usually associated with
elevation of arterial blood pressure above 200 mmHg for some time
irrespective of the use or not of preoperative alpha-adrenergic
blockade. Attempts at controlling the elevated blood pressure usually
involve the use of many drugs through induction, maintenance,
termination and post operative period. We recently used a combined
general and epidural anaesthesia for excision of a huge
phaeochromocytoma in a 24 yr old Nigerian lady with a satisfactory
outcome. The combined technique seemed to have modified the anaesthetic
course considerably, resulting in the use of fewer drugs and a steady
haemodynamic state which is very unusual in anaesthesising patients with
phaeochromocytoma (see haemodynamic record Illustration II).
Post-operative analgesia was provided with morphine given through the
epidural catheter.
21
UI - 11715546
AU - Sun Z; Wang Y; Li Z
TI -
[Recurrent pheochromocytoma]
SO - Zhonghua Wai Ke Za Zhi 1998 Jan;36(1):59-60
AD - Department of Urology, First Affiliated Hospital, China Medical
University, Shenyang 110001.
OBJECTIVE: To improve the diagnosis of recurrent pheochromocytoma.
METHODS: To study 11 cases of recurrent pheochromocytoma treated from
1970 to 1996. RESULTS: The recurrence was due to the metastasis of
malignant tumor and the multifocal occurrence of benign one.
Extraadrenal pheochromocytomas tended to occur at several sites or
metastasize. The metastatic places usually no show pheochromatic
tissues, and the recurrent benign tumors were liable to grow at
extraadrenal regions. The nature of recurrent tumors should be judged
according to variant factors. CONCLUSION: The recurrent
pheochromocytomas are not malignant in nature, but they have
considerable malignant tendency and should undergo intensive
survelliance and regular examinations especially for the primary or
recurrent extraadrenal pheochromocytomas.
22
UI - 11506307
AU - Moritani H; Sakamoto M; Yoshida Y; Nasu H; Nemoto R; Nakamura I
TI -
Pheochromocytoma of the urinary bladder revealed with cerebral
hemorrhage.
SO - Intern Med 2001 Jul;40(7):638-42
AD - Department of Cardiology, Tottori Prefectural Central Hospital,
Tottori-shi.
The case was a 51-year-old man, who has been undergoing treatment with
oral medication for hypertension for three years. The patient was
admitted to the author's clinic for hemorrhage in the left putamen. He
was diagnosed as having primary pheochromocytoma of the bladder from
such symptoms as paroxysmal blood pressure elevation after urination,
mild increase in catecholamine levels before and after urination, and
from the results of 131I-MIBG scintigraphy, and cystoscopy, and
underwent excision of the bladder tumor. Upon endocrinological
examination, only mild increases in catecholamine levels were found.
Therefore, constant monitoring of blood pressure and 131I-MIBG
scintigraphy were useful for a definitive diagnose.
23
UI - 11759939
AU - Sharma N; Kumari S; Jain S; Varma S
TI -
Pheochromocytoma: a 10-year experience in a tertiary care North Indian
hospital.
SO - Indian Heart J 2001 Jul-Aug;53(4):481-5
AD - Department of Internal Medicine, Postgraduate Institute of Medical
Education and Research, Chandigarh. medinst@pgi.chd.nic.in
BACKGROUND: The study was carried out to highlight the clinical and
biochemical profile of patients with pheochromocytoma in a tertiary care
center of North India. METHODS AND RESULTS: Thirty consecutive cases of
pheochromocytoma admitted over a period of 10 years to our Institute
were analyzed. The chief clinical complaints of these 30 patients (17
males and 13 females, mean age 24+/-7 years) were palpitation (80%),
headache (77%), sweating (60%), breathlessness (67%) and flushing (56%).
The clinical triad of headache, flushing and sweating occurred in 26.7%
of cases. On clinical examination, 97% of the patients were hypertensive
and 16.6% presented with malignant hypertension. Laboratory measurements
showed that the levels of 24-hour urinary vanillylmandelic acid were
elevated in 80% of cases. Levels of plasma adrenaline and noradrenaline
were raised in 78% and 79% of cases, respectively. Anatomical
localization of the tumor on computerized tomographic scan showed the
presence of an adrenal tumor in 80% and extra-adrenal tumor in 20%.
Surgical removal of the tumor could be carried out in 28 cases following
control of the blood pressure with antihypertensive drugs including
alpha and beta adrenoreceptor blockers. CONCLUSIONS: Pheochromocytoma
should be suspected in all young hypertensive persons. The appropriate
therapy for this tumor is surgical removal preceded by adequate blood
pressure control including the use of alpha and beta adrenoreceptor
antagonists.
24
UI - 11715896
AU - Ather MH; Altaf S; Memon A
TI -
A critical step in the operative management of non-functioning
asymptomatic incidentaloma.
SO - J Pak Med Assoc 2001 Aug;51(8):299-300
AD - Section of Urology, Department of Surgery, Aga Khan University Hospital,
Karachi.
25
UI - 11767369
AU - Arnault-Ouary G; Chatal JF; Charbonnel B
TI -
[Pheochromocytoma]
SO - Rev Prat 1998 Apr 1;48(7):744-8
AD - Clinique d'endocrinologie Maladies metaboliques et nutrition, Hotel-Dieu
44093 Nantes.
Pheochromocytoma is a tumor secreting catecholamines and is most often a
sporadic and benign adrenal tumor. But in some cases the tumor is
extra-adrenal (10%), malignant (10%) or familial (10%) and in this last
case frequently bilateral. The clinical expression of pheochromocytoma
is typically hypertension, with paroxysms including headache, excessive
sweating, palpitations, but various clinical presentations can be
observed. The biological diagnosis is represented by the measurement of
urinary catecholamines. The most sensitive and specific test is the
measurement of urinary metanephrines or of plasma methoxyamines. The
tumor localization is generally easy using CT scan and (or) NMR imaging,
associated with MIBG scintigraphy. The treatment is surgical after
medical management.
26
UI - 11767320
AU - Kato T; Takase H; Waguri Y; Ikeda K; Takahashi M
TI -
Epidural anaesthesia for insertion of a femoral neck prosthesis in a
patient with phaeochromocytoma.
SO - Eur J Anaesthesiol 1993 Nov;10(6):441-4
AD - Department of Anesthesiology, Toyokawa City Hospital, 1-19 Komei-cho,
Toyokawa, Aichi 442, Japan.
A hemiarthroplasty for femoral neck fracture was successfully performed
under combined epidural anaesthesia and light general anaesthesia before
phaeochromocytoma removal. Pre-operative therapy was managed with
doxazosin, enalapril and diltiazem. Peri-operative management
facilitated maintenance of stable haemodynamic conditions.
Post-operative pain management was provided with continuous 1%
lignocaine infusion via an epidural catheter. The phaeochromocytoma was
finally removed uneventfully 7 weeks after hemiarthroplasty.
27
UI - 1973879
AU - Grosse H; Schroder D; Schober O; Hausen B; Dralle H
TI -
[The importance of high-dose alpha-receptor blockade for blood volume
and hemodynamics in pheochromocytoma]
SO - Anaesthesist 1990 Jun;39(6):313-8
AD - Zentrum Anaesthesiologie, Abteilung I, Medizinische Hochschule Hannover.
This prospective clinical study evaluates the possible beneficial
effects of increased phenoxybenzamine dosage in the preoperative
treatment of patients with pheochromocytoma. For this purpose total
blood volume (TBV) prior to and after treatment with phenoxybenzamine
and hemodynamic changes during surgery were determined in two groups of
patients: group I (n = 12) received a mean dosage of 140 mg, group II (n
= 12) 270 mg/day. The mean TBV in group I showed no changes after
treatment with phenoxybenzamine, while the TBV in group II increased by
5.6 ml/kg body weight, corresponding to an increase in plasma volume
(PV) of 10.2%. These changes were not significant, however. The
intraoperative vasodilator requirement for the treatment of
catecholamine induced hypertension during tumor manipulation was
significantly less for group II: total nitroprusside administration
averaged 8.7 mg in group I and 0.8 mg in group II (P less than 0.0005).
Patients in group I received a total of 2.6 mg nitroglycerin compared
with only 0.5 mg for patients in group II (P less than 0.005). In
conclusion, preoperative treatment of patients with pheochromocytoma
with increased dosages of phenoxybenzamine is beneficial to
intraoperative management by decreasing hemodynamic instability due to
tumor manipulation and following resection. This treatment was effective
for preventing complications such as excessive tachycardia, cardiac
arrhythmias, hypertensive crises, or left ventricular failure.
28
UI - 11640997
AU - Ishii C; lnoue K; Negishi K; Tane N; Awata T; Katayama S
TI -
Diabetic ketoacidosis in a case of pheochromocytoma.
SO - Diabetes Res Clin Pract 2001 Nov;54(2):137-42
AD - The Fourth Department of Medicine, Saitama Medical School, 38 Morohongo,
Moroyama-Machi, Saitama 350-0495, Iruma-Gun, Japan.
cishii-nsh@umin.ac.jp
A 31-year-old woman was admitted to our hospital because of diabetic
ketoacidosis (DKA). Ultrasound sonography revealed the existence of the
left adrenal tumor and endocrinological examinations established a
diagnosis of pheochromocytoma. She had been healthy and there was no
evidence for gestational diabetes in her personal history.
Characteristic features were not found in her tumor size and the
catecholamine levels as compared with typical cases of pheochromocytoma.
An overwhelming secretion of catecholamine might suppress insulin
secretion, as evidenced by the improvement after the resection of the
tumor. However, a significant insulin resistance continued after tumor
resection. Obesity and the heterozygosity of beta3-adrenergic receptor
gene (Try64Arg) might play a role in insulin resistance, which resulted
in DKA at least in part. Literature survey revealed four cases of DKA in
the patients with pheochromocytoma including ours, three of which were
Japanese. Pancreatic capacity to secrete insulin has been reported to be
less than Caucasians, which might be another reason for DKA. Thus, we
speculate that both suppressed insulin secretion and insulin resistance
deteriorated by obesity or other factor(s) such as abnormality in beta3
adrenergic receptor probably depress beta-cell function resulting in
abnormal metabolic imbalance such as DKA.
29
UI - 11572905
AU - Kuzmanovska D; Sahpazova E; Kocova M; Damjanovski G; Popov Z
TI -
Phaeochromocytoma associated with reversible renal artery stenosis.
SO - Nephrol Dial Transplant 2001 Oct;16(10):2092-4
AD - Department of Nephrology, University Pediatric Clinic, Skopje, R.
Macedonia.
30
UI - 11572908
AU - Kolhe N; Stoves J; Richardson D; Davison AM; Gilbey S
TI -
Hypertension due to phaeochromocytoma--an unusual cause of multiorgan
failure.
SO - Nephrol Dial Transplant 2001 Oct;16(10):2100-4
AD - Department of Renal Medicine, St James's University Hospital, Leeds, UK.
31
UI - 11742341
AU - Li ML; Fitzgerald PA; Price DC; Norton JA
TI -
Iatrogenic pheochromocytomatosis: a previously unreported result of
laparoscopic adrenalectomy.
SO - Surgery 2001 Dec;130(6):1072-7
AD - University of California, San Francisco, Calif., USA.
BACKGROUND: Laparoscopic adrenalectomy is now regarded as the procedure
of choice for treatment of small or benign adrenal tumors, including
pheochromocytoma. However, long-term outcomes have not been critically
assessed. We report here 3 cases of pheochromocytomatosis recurring 3 to
4 years after laparoscopic adrenalectomy. We postulate
laparoscopic-induced seeding of tumor as the mechanism of recurrence.
METHODS: We retrospectively reviewed the cases of 3 patients with
documented biochemical and radiolabeled metaiodobenzylguanidine evidence
of recurrent pheochromocytoma after prior presumed curative laparoscopic
adrenalectomy. RESULTS: Original pheochromocytomas were 5.5 to 6.5 cm in
diameter. At the time of laparoscopic adrenalectomy, tumors were not
believed to be malignant, based on clinical or histopathologic data.
However, on 3- to 4-year follow-up, each patient developed symptoms,
elevated urinary catecholamine levels, and metaiodobenzylguanidine
imaging consistent with recurrence. At reoperation, multiple small tumor
nodules were found in the adrenal bed near the site of the initial
laparoscopic resection. The original operative notes suggested some
possible method of local seeding: tumor fragmentation and spillage or
excessive tumor manipulation. CONCLUSIONS: Pheochromocytoma recurrence
may occur as a result of local spillage of tumor during laparoscopic
adrenalectomy. The relative risk of recurrence between open and
laparoscopic resection needs to be assessed. Long-term follow-up will
continue to be important, regardless of operative approach.
32
UI - 11510758
AU - Tomita N; Moriguchi A; Yamasaki K; Taniyama Y; Kotani N; Hashiya N;
TI -
Yoshida M; Yao M; Higaki J; Ogihara T
A family with von Hippel-Lindau disease revealed by pheochromocytoma.
SO - Hypertens Res 2001 Jul;24(4):445-50
AD - Department of Geriatric Medicine, Osaka University Medical School,
Suita, Japan. tomita@hp-gm.med.osaka-u.ac.jp
Von Hippel-Lindau (VHL) disease is an inherited neoplastic disease
characterized by a predisposition to develop retinal angiomas, central
nervous system hemangioblastomas, renal cell carcinomas, pancreatic
cysts and pheochromocytomas. Recently, we encountered three members of
the same family who each had both VHL disease and pheochromocytoma. As
in all three patients we suspected pheochromocytoma, the diagnosis of
VHL disease should be considered. The possible presence of VHL disease
was initially investigated in all three patients based on the presence
of pheochromocytoma. A mutational analysis of the VHL gene revealed the
presence of a missense mutation, consisting of a G to A transversion, at
nucleotide 713 in all three patients. This germline point mutation in
the VHL gene is often detected in type 2 VHL disease with
pheochromocytoma. Genetic analysis seems to be useful for early
detection of VHL disease, even when the formal criteria for diagnosis of
this disease are lacking.
33
UI - 11701346
AU - Shapiro B; Gross MD; Shulkin B
TI -
Radioisotope diagnosis and therapy of malignant pheochromocytoma.
SO - Trends Endocrinol Metab 2001 Dec;12(10):469-75
AD - The Nuclear Medicine Service, Dept of Veterans Affairs, Ann Arbor, MI
48105, USA. bshapir@umich.edu
The availability of radiopharmaceuticals to depict primary malignant
pheochromocytoma and its metastases has markedly changed the approach to
these unusual cancers. Whole body screening afforded by scintigraphy
allows remote tumor involvement to be identified and provides staging
information necessary to guide subsequent therapy. The avid accumulation
by malignant pheochromocytoma of some radiopharmaceuticals used for
scanning has shown promise in therapeutic trials. In this paper, we
discuss radiopharmaceuticals presently employed in malignant
pheochromocytoma for both diagnostic and therapeutic uses and potential
future compounds that may find their way into clinical practice in the
approach to these and other related neoplasms.
34
UI - 11816951
AU - McCurry T; Bybee DE; Skaggs G; Richardson JD
TI -
Pheochromocytoma.
SO - J Ky Med Assoc 2001 Nov;99(11):487-92
AD - Department of Surgery, University of Louisville, Louisville, Ky. 40292,
USA.
Causes of hypertension that are amenable to surgical treatment
constitute a very small but potentially important segment of the
hypertensive population. These causes (which constitute frequently asked
questions for medical students) include coarctation of the aorta,
aldosterone and corticosteroid-producing tumors of the adrenal glands,
lesions producing decreased renal blood flow, and pheochromocytoma. This
latter tumor is quite uncommon, with a frequency of roughly one per
million, but often produces dramatic hypertensive episodes. Due to its
rarity, physicians in practice may not consider the diagnosis and
appropriately evaluate the patient. We present the case histories of
three patients with pheochromocytoma who demonstrate important features
of this disease. Diagnostic evaluation and principles of treatment will
be discussed.
35
UI - 11789820
AU - Kumar P; Walcot N; Carpenter R; Uppal R
TI -
Concomitant off-pump myocardial revascularization and pheochromocytoma
resection.
SO - Ann Thorac Surg 2001 Dec;72(6):2139-41
AD - Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London,
England.
Surgical management of patients with coexisting ischemic heart disease
and pheochromocytoma remains challenging. We present one such case in
which hybrid myocardial revascularization (angioplasty with stenting and
off-pump coronary artery bypass grafting) and resection of
pheochromocytoma were undertaken. Unusual features included simultaneous
coronary artery surgery and tumor resection and, in particular, coronary
artery surgery being performed without cardiopulmonary bypass.
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