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Deng Y, Wang H, Guo X, Jiang S, Cai J. Long-term blood pressure outcomes of laparoscopic adrenalectomy in trHTN patients. J Transl Int Med 2023; 11:275-281. [PMID: 37662893 PMCID: PMC10476474 DOI: 10.2478/jtim-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background and Objectives Treatment resistant hypertension (trHTN) is a common clinical problem faced by many clinicians. Laparoscopic adrenalectomy effectively trims blood pressure (BP) elevation secondary to various functional adrenal disorders. However, the impact of adrenalectomy on BP within trHTN patients has never been reported. Our present study aims to investigate the effect of adrenalectomy on BP management within trHTN patients, and to explore clinical predictors for postoperative BP normalization. Patients and Methods In our current study, 117 patients diagnosed with trHTN and performed with unilateral adrenalectomy were consecutively enrolled, demographic and medical information were documented for baseline data collection. BP was measured with a standard electronic sphygmomanometer twice a day. Long-term periodical interview was conducted and 109 (93.2%) enrolled patients were successfully followed-up at an averaged 36.2 months. Results At follow-up, 27/109 (25%) trHTN patients acquired BP normalization and 68/109 (62%) patients acquired BP improvement. Mean taking anti-hypertensive agents reduced from presurgical 4.24 to present 1.21 (P < 0.01), along with 7.2 mmHg reduction in SBP (P < 0.01). Image macro-adenoma and hypokalemia history were found to be the two strongest predictors for postoperative BP normalization. (χ2= 28.032, P < 0.01). The incidence of adverse postoperative events was quite small. Conclusions In summary, this current study implicates that adrenalectomy is an efficacious and safe surgical strategy for BP management in trHTN patients. Patients with both unilateral macro-adenoma and hypokalemia are more prone to acquire postoperative BP normalization.
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Affiliation(s)
- Yue Deng
- Hypertension Center of Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
| | - Hanbo Wang
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan271016, Shandong Province, China
| | - Xudong Guo
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan271016, Shandong Province, China
| | - Shaobo Jiang
- Department of Urology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan271016, Shandong Province, China
| | - Jun Cai
- Hypertension Center of Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
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2
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Tang SS, Lee JWK, Wijerethne S, Iyer SG, Hue S, En NM, Parameswaran R. Locally invasive recurrence or metastasis of pheochromocytoma into the liver?—clinicopathological challenges. World J Surg Oncol 2022; 20:360. [DOI: 10.1186/s12957-022-02817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractPheochromocytomas (PCC) are rare and functional neuroendocrine tumors developing from adrenal chromaffin cells. Predicting malignant behavior especially in the absence of metastasis can be quite challenging even in the era of improved understanding of the molecular mechanisms involved in PCCs. Currently, two histopathological grading systems Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) score are used in clinical practice, but these are subject to significant interobserver variability. Some of the most useful clinical factors associated with malignancy are large size ([4–5 cm), and genetic features such as presence of SDHB germline mutations. Local invasion is uncommon in PCC and metastasis seen in 10 to 17% but higher in germline mutations and when this occurs management can be challenging. Here, we report on a case with challenges faced by the pathologist and clinicians alike in diagnosis and management of PCC recurrence.
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3
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Laparoscopic Surgery for Pheochromocytoma in Hemodialysis Patients. Int J Nephrol 2022; 2022:3060647. [PMID: 35910424 PMCID: PMC9334043 DOI: 10.1155/2022/3060647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/01/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives We analyzed the clinical outcomes of laparoscopic adrenalectomy for pheochromocytomas in hemodialysis compared with nonhemodialysis patients. Methods Fifty-seven patients (7 hemodialysis and 50 nonhemodialysis) were included in the study. We analyzed the differences in clinical parameters and outcomes between the hemodialysis patient groups and nonhemodialysis patient groups as well as identified predictors for an intraoperative hypertensive spike. Results The increasing intravascular volume before surgery in hemodialysis patients made perioperative hemodynamic management safer. No significant difference in clinical parameters between the two groups was observed except for the length of hospitalization that was significantly longer in the hemodialysis patients (9 vs. 6 days, P=0.005). An increase in systolic blood pressure at CO2 insufflation was an independent predictor of a hypertensive spike with a cutoff value of 22.5 mmHg (odds ratio 1.038, 95% confidence interval 1.012–1.078). Conclusion Laparoscopic adrenalectomy for pheochromocytomas in hemodialysis was safe and feasible. An increase in systolic blood pressure at CO2 insufflation was a predictor of the intraoperative hypertensive spike. The research in this manuscript is not registered. This is a retrospective study.
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4
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Khan Z. An Interesting Case of Treatment-Resistant Ventricular Tachycardia Secondary to Pheochromocytoma and Left Ventricular Non-compaction. Cureus 2022; 14:e25483. [PMID: 35800814 PMCID: PMC9246457 DOI: 10.7759/cureus.25483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/23/2022] Open
Abstract
A 51-year-old patient was admitted with chest pain and broad complex ventricular tachycardia. He received three consecutive direct cardioversion (DC) shocks and was commenced on amiodarone infusion via a central venous catheter or central line (CVC). He responded to treatment and normal sinus rhythm (NSR) was achieved. He had elevated troponin I and underwent coronary angiogram which initially was thought to be responsible for his ventricular tachycardia. Coronary angiogram (CAG) showed unobstructed coronary arteries. He was recently diagnosed with pheochromocytoma and was commenced on Phenoxybenzamine 10 mg two months back. He developed ventricular tachycardia (VT) again the next day that did not respond to four consecutive direct cardioversion shocks (DC) and antiarrhythmic medications. He was intubated and ventilated to terminate his VT and was transferred to the intensive care unit (ICU). He remained intubated for 48 hours and he remained in NSR, after which he was extubated. He was commenced on bisoprolol and was later stepped down to the coronary care unit (CCU). Cardiac magnetic resonance imaging (CMR) showed left ventricular non-compaction (LVNC) or possibly myocarditis in view of patient's known history of pheochromocytoma. He was discussed with surgical team at another hospital for surgical resection of the adrenal tumor and had a few further runs of VT while he was waiting to be transferred. The patient finally underwent surgical resection of the tumor and was booked for implantable cardioverter defibrillator (ICD) in view of his VT. This was an interesting case of treatment-resistant VT driven by pheochromocytoma and LVNC, and it is important to be familiar with the fact that conventional therapies may fail in these patients and may require intubation and ventilation to terminate VT storms.
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Research on the Damage of Adrenal Pheochromocytoma to Patients’ Cardiovascular Vessels and Its Correlation with Hypertension. JOURNAL OF ONCOLOGY 2022; 2022:3644212. [PMID: 35186079 PMCID: PMC8856813 DOI: 10.1155/2022/3644212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/28/2023]
Abstract
Chromaffin cell-centered pheochromocytoma (Pheo) is a rare tumour. Pheochromocytoma and how it affects the heart will be the topic of this article. Due to the comparable symptoms and indications of the sympathetic nervous system, a pheochromocytoma might be difficult to detect early. There are also other frequent differential diagnoses that might delay the detection of a pheochromocytoma. One of the most common side effects of pheochromocytoma is unmanageable hypertension. Hypertensive crisis (extreme increases in blood pressure) can develop, which is a life-threatening condition that leads to strokes or arrhythmia. Estimated to affect African Americans significantly, they frequently go undetected due to a lack of resources or accessibility of services. Because this tumour is difficult to identify and its symptoms often resemble those of other diseases, it is frequently overlooked. A pheochromocytoma's long-term consequences can include cardiac muscle deterioration, congestive heart failure (CHF), a higher diabetes risk and possibly death. Masked hypertension (MH) is more common in people with adrenal pheochromocytoma, which has been related to an increased risk of heart disease. With the use of ambulatory blood pressure monitoring, this research set out to find out how common mental health issues are among people with APs. There were 85 participants in all, 43 of whom had APs and 42 of whom had the same age, gender, BMI, smoking and diabetes as the AP patients. Measurements were made of the BP and AP in both the diseased and control groups. Retrospective data collection was used to gather biochemical, hormonal and radiological information on the patients. The Pearson–Boltzmann CNN method was then used to assess risk based on the diagnosis results. Furthermore, depending on the risk score, more nonselective blockers (e.g., prazosin, doxazosin, terazosin, and metyrosine) have been used to lower perioperative catecholamine levels, hence reducing illness risk. After a successful surgical excision of the tumour, the recommended therapy can usually be stopped quickly.
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6
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Immunomodulatory Potential of Diuretics. BIOLOGY 2021; 10:biology10121315. [PMID: 34943230 PMCID: PMC8698805 DOI: 10.3390/biology10121315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
In this review, diuretics and their immunomodulatory functions are described. The effects on the immune response of this group of drugs are reported in patients suffering from hypertension and under experimental conditions involving animal models and cell line studies. The pathogenesis of hypertension is strongly connected to chronic inflammation. The vast majority of diuretics modulate the immune response, changing it in favor of the anti-inflammatory response, but depending on the drug, these effects may differ. This topic is significantly important in medical practice regarding the treatment of patients who have coexisting diseases with chronic inflammatory pathogenesis, including hypertension or chronic heart failure. In patients with metabolic syndrome, allergies, or autoimmune disorders, the anti-inflammatory effect is favorable, because of the overstimulation of their immune system. Otherwise, in the geriatric population, it is important to find the proper anti- and pro-inflammatory balance to avoid an enhancement of immune response suppression, which can result in reducing the risk of serious infections that can occur due to the age-diminished function of the immune system. This article is intended to facilitate the selection of an antihypertensive drug that depends on the patient's immune situation.
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7
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Faris M, Baliss M, Coni R, Nambudiri V. Severe Hypertension Leading to Hemorrhagic Stroke in Neurofibromatosis Type 1. Cureus 2021; 13:e14658. [PMID: 33907652 PMCID: PMC8066756 DOI: 10.7759/cureus.14658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neurofibromatosis type 1 (NF-1), also known as von Recklinghausen’s disease, is an autosomal dominant multisystem genetic disorder affecting one in 2,600 individuals. It is caused by a mutation of the NF-1 gene located on chromosome 17q11.2. It is characterized by various cutaneous findings, including cafe-au-lait spots and axillary freckling. Hypertension is a commonly reported finding in adult patients with NF-1 but may also develop during childhood. In most cases, hypertension in NF-1 patients is primary in nature; however, secondary hypertension has been more frequently reported in NF-1 patients due to the association of NF-1 with an increased incidence of pheochromocytomas, bilateral renal artery stenosis, and coarctation of the abdominal aorta. This case reports the consequences of uncontrolled hypertension in a 23-year-old female with NF-1, illustrating the importance of screening for hypertension in children diagnosed with NF-1, and emphasizing the higher incidence of both primary and secondary causes of hypertension in the NF-1 patient population. In this case, no secondary causes of hypertension were found; therefore, a diagnosis of primary hypertension was made and the appropriate therapy was initiated to prevent further complications.
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Affiliation(s)
- Mohamed Faris
- Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Michelle Baliss
- Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Robert Coni
- Neurology, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Vinod Nambudiri
- Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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8
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Nazari MA, Rosenblum JS, Haigney MC, Rosing DR, Pacak K. Pathophysiology and Acute Management of Tachyarrhythmias in Pheochromocytoma: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 76:451-464. [PMID: 32703516 DOI: 10.1016/j.jacc.2020.04.080] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/11/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
Abstract
Pheochromocytomas, arising from chromaffin cells, produce catecholamines, epinephrine and norepinephrine. The tumor biochemical phenotype is defined by which of these exerts the greatest influence on the cardiovascular system when released into circulation in high amounts. Action on the heart and vasculature can cause potentially lethal arrhythmias, often in the setting of comorbid blood pressure derangements. In a review of electrocardiograms obtained on pheochromocytoma patients (n = 650) treated at our institution over the last decade, severe and refractory sinus tachycardia, atrial fibrillation, and ventricular tachycardia were found to be the most common or life-threatening catecholamine-induced tachyarrhythmias. These arrhythmias, arising from catecholamine excess rather than from a primary electrophysiologic substrate, require special considerations for treatment and complication avoidance. Understanding the synthesis and release of catecholamines, the adrenoceptors catecholamines bind to, and the cardiac and vascular response to epinephrine and norepinephrine underlies optimal management in catecholamine-induced tachyarrhythmias.
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Affiliation(s)
- Matthew A Nazari
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Internal Medicine and Pediatrics, MedStar Georgetown University Hospital, Washington, DC. https://twitter.com/NazariMatthew
| | - Jared S Rosenblum
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark C Haigney
- Division of Cardiology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Division of Cardiology, Department of Medicine, Walter Reed National Military Medical Center, and Herbert School of Medicine, Bethesda, Maryland
| | - Douglas R Rosing
- Division of Cardiology, Department of Medicine, Walter Reed National Military Medical Center, and Herbert School of Medicine, Bethesda, Maryland; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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9
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Long-term blood pressure outcomes of laparoscopic adrenalectomy in trHTN patients. J Transl Int Med 2021. [DOI: 10.2478/jtim-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and Objectives
Treatment resistant hypertension (trHTN) is a common clinical problem faced by many clinicians. Laparoscopic adrenalectomy effectively trims blood pressure (BP) elevation secondary to various functional adrenal disorders. However, the impact of adrenalectomy on BP within trHTN patients has never been reported. Our present study aims to investigate the effect of adrenalectomy on BP management within trHTN patients, and to explore clinical predictors for postoperative BP normalization.
Patients and Methods
In our current study, 117 patients diagnosed with trHTN and performed with unilateral adrenalectomy were consecutively enrolled, demographic and medical information were documented for baseline data collection. BP was measured with a standard electronic sphygmomanometer twice a day. Long-term periodical interview was conducted and 109 (93.2%) enrolled patients were successfully followed-up at an averaged 36.2 months.
Results
At follow-up, 27/109 (25%) trHTN patients acquired BP normalization and 68/109 (62%) patients acquired BP improvement. Mean taking anti-hypertensive agents reduced from presurgical 4.24 to present 1.21 (P = 0.000), along with 7.2 mmHg reduction in SBP (P = 0.000). Image macro-adenoma and hypokalemia history were found to be the two strongest predictors for postoperative BP normalization. (χ2
= 28.032, P = 0.000). The incidence of adverse postoperative events was quite small.
Conclusions
In summary, this current study implicates that adrenalectomy is an efficacious and safe surgical strategy for BP management in trHTN patients. Patients with both unilateral macro-adenoma and hypokalemia are more prone to acquire postoperative BP normalization.
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10
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Sohail S, Shafiq W, Raza SA, Zahid A, Mir K, Azmat U. Clinical Characteristics and Outcome of Patients With Pheochromocytoma: A Single Center Tertiary Care Experience. Cureus 2020; 12:e7990. [PMID: 32523845 PMCID: PMC7274258 DOI: 10.7759/cureus.7990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to evaluate the demographic and clinical characteristics of patients with pheochromocytoma and determine the treatment outcome with overall survival rates of patients with pheochromocytoma. Methods A retrospective, cross-sectional study was performed on all the patients with histologically proven pheochromocytoma presenting to Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC) Lahore, between August 2006 and July 2018. Clinical, biochemical and radiological data were collected at presentation, post-surgery, at discharge and till the last follow-up; data was retrieved from hospital records. Cure was defined as no evidence of disease biochemically, clinically, and structurally. Results This study included 29 patients, 69% were female. The three most common symptoms were abdominal pain (51.7%), hypertension (44.8%) and headache (41.4%). Most pheochromocytomas were sporadic (82.8%), all were adrenal gland tumors, and 89.7% were unilateral. All patients underwent adrenalectomy. Open adrenalectomy was performed in 25 patients whereas four underwent laparoscopic adrenalectomy. Fifteen patients experienced postoperative complications. The most frequently documented intraoperative complication was hypotension. Death occurred in two patients, one patient died of metastatic disease secondary to malignant pheochromocytoma and the other patient died from perioperative complications. Cure was documented biochemically and/or radiologically in 96.5% patients. Conclusions Abdominal pain was predominant presenting feature most likely due to large tumor size. Most patients presenting to SKMCH & RC, had large intra-abdominal tumors with high cure rate. Mortality was low despite high rate of perioperative complications.
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Affiliation(s)
- Sara Sohail
- Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Waqas Shafiq
- Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Syed Abbas Raza
- Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Adnan Zahid
- Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Khurram Mir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Umal Azmat
- Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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11
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Phillips J, Bloom J, Yarlagadda V, Schultz L, Gordetsky J, Tanno FY, Chambo JL, Almeida MQ, Fragoso MC, Srougi M, Srougi V, Rais-Bahrami S. Internal validation and decision curve analysis of a preoperative nomogram predicting a postoperative complication in pheochromocytoma surgery: An international study. Int J Urol 2020; 27:463-468. [PMID: 32236993 DOI: 10.1111/iju.14221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop a preoperative nomogram that would predict the risk of a postoperative complication for pheochromocytoma patients undergoing adrenalectomy using an international database. METHODS We retrospectively analyzed preoperative variables and postoperative outcomes in patients who underwent adrenalectomy for pheochromocytoma in three institutions from 2000 to 2017. Internal validation of a generated nomogram was carried out with receiver operating characteristics, calibration plots, and decision curve analyses. RESULTS A total of 153 patients who had undergone 166 adrenalectomies were included in the study. Overall, post-adrenalectomy complications were seen in 30% of patients, whereas 9.6% of patients sustained a Clavien ≥3a complication. Independent predictors of a complication were a history of hypertension, body mass index, tumor size, and Charlson Comorbidity Index score. On internal validation, the multivariable model generated a nomogram that predicted a postoperative complication or clinically hemodynamic event with an area under the curve of 0.86, showed good calibration and had an overall net benefit. CONCLUSIONS An internally validated nomogram combining body mass index, Charlson Comorbidity Index score and tumor size can predict the probability of a post-adrenalectomy complication in those with and without hypertension. The model, the first of its kind in pheochromocytoma surgery, identifies patients at risk of a postoperative complication at the time of their presentation with pheochromocytoma.
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Affiliation(s)
- John Phillips
- Department of Urology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Jonathan Bloom
- Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Vidhush Yarlagadda
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luciana Schultz
- and, Department of, Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Gordetsky
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,and, Department of, Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Fabio Y Tanno
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose L Chambo
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Madson Q Almeida
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Cbv Fragoso
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Victor Srougi
- Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Soroush Rais-Bahrami
- Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Violari EG, Arici M, Singh CK, Caetano CM, Georgiades CS, Grady J, Tendler BR, Shichman SJ, Malchoff CD. Adrenal vein sampling with and without cosyntropin stimulation for detection of surgically remediable aldosteronism. Endocrinol Diabetes Metab 2019; 2:e00066. [PMID: 31008369 PMCID: PMC6458460 DOI: 10.1002/edm2.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/10/2018] [Accepted: 02/18/2019] [Indexed: 11/16/2022] Open
Abstract
CONTEXT AND OBJECTIVE Bilateral adrenal vein sampling (AVS), the diagnostic standard for identifying surgically remediable aldosteronism (SRA), is commonly performed after cosyntropin stimulation (post-ACTHstim). The role of AVS without cosyntropin stimulation (pre-ACTHstim) has not been established. The selectivity index (SI), the adrenal vein (av) serum cortisol concentration divided by that in a peripheral vein, confirms av sampling. The minimally acceptable SI is controversial. The objectives of this study were to determine the role of pre-ACTHstim AVS and a predetermined SI. DESIGN Using biochemical cure as the endpoint, we performed a retrospective head-to-head comparison of pre-ACTHstim AVS to post-ACTHstim AVS. The specificity of a predetermined minimum SI of 1.5 in pre-ACTHstim AVS was determined. PATIENTS At a regional AVS referral centre, we analysed 32 patients who had undergone simultaneous bilateral AVS both pre- and post-ACTHstim and had returned for postadrenalectomy evaluation. MEASUREMENTS Simultaneous bilateral AVS was performed with measurements of venous concentrations of aldosterone and cortisol. End points were postadrenalectomy plasma renin activity, serum aldosterone concentration, and number of antihypertensive medications. RESULTS All 32 patients achieved a biochemical cure following adrenalectomy. The two AVS protocols were complementary. Notably, seven patients (22%; CI = 11-38) were found to have SRA by a lateralization index (LI) > 4 on the pre-ACTHstim AVS, but not on the post-ACTHstim AVS. SI pre-ACTHstim was divided into tertiles. Specificity was 100% in all. CONCLUSIONS Simultaneous bilateral AVS performed both pre-ACTHstim and post-ACTHstim maximizes SRA identification. A SI of 1.5 pre-ACTHstim does not reduce specificity.
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Affiliation(s)
| | - Melih Arici
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
| | | | - Celina M. Caetano
- Department of Medicine, Division of Endocrinology and Neag Comprehensive Cancer CenterUConn HealthFarmingtonConnecticut
| | | | - James Grady
- Department of Clinical and Translational ScienceBiostatistics CenterFarmingtonConnecticut
| | - Beatriz R. Tendler
- Department of Medicine, Division of Endocrinology and Neag Comprehensive Cancer CenterUConn HealthFarmingtonConnecticut
| | | | - Carl D. Malchoff
- Department of Medicine, Division of Endocrinology and Neag Comprehensive Cancer CenterUConn HealthFarmingtonConnecticut
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13
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Eisenhofer G, Prejbisz A, Peitzsch M, Pamporaki C, Masjkur J, Rogowski-Lehmann N, Langton K, Tsourdi E, Pęczkowska M, Fliedner S, Deutschbein T, Megerle F, Timmers HJLM, Sinnott R, Beuschlein F, Fassnacht M, Januszewicz A, Lenders JWM. Biochemical Diagnosis of Chromaffin Cell Tumors in Patients at High and Low Risk of Disease: Plasma versus Urinary Free or Deconjugated O-Methylated Catecholamine Metabolites. Clin Chem 2018; 64:1646-1656. [DOI: 10.1373/clinchem.2018.291369] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023]
Abstract
Abstract
BACKGROUND
Measurements of plasma or urinary metanephrines are recommended for diagnosis of pheochromocytoma and paraganglioma (PPGL). What test offers optimal diagnostic accuracy for patients at high and low risk of disease, whether urinary free metanephrines offer advantages over deconjugated metanephrines, and what advantages are offered by including methoxytyramine in panels all remain unclear.
METHODS
A population of 2056 patients with suspected PPGLs underwent prospective screening for disease using mass spectrometric-based measurements of plasma free, urinary deconjugated, and urinary free metanephrines and methoxytyramine. PPGLs were confirmed in 236 patients and were excluded in others on follow-up evaluation.
RESULTS
Measurements of plasma free metabolites offered higher (P < 0.01) diagnostic sensitivity (97.9%) than urinary free (93.4%) and deconjugated (92.9%) metabolites at identical specificities for plasma and urinary free metabolites (94.2%) but at a lower (P < 0.005) specificity for deconjugated metabolites (92.1%). The addition of methoxytyramine offered little value for urinary panels but provided higher (P < 0.005) diagnostic performance for plasma measurements than either urinary panel according to areas under ROC curves (0.991 vs 0.972 and 0.964). Diagnostic performance of urinary and plasma tests was similar for patients at low risk of disease, whereas plasma measurements were superior to both urinary panels for high-risk patients.
CONCLUSIONS
Diagnosis of PPGLs using plasma or urinary free metabolites provides advantages of fewer false-positive results compared with commonly measured deconjugated metabolites. The plasma panel offers better diagnostic performance than either urinary panel for patients at high risk of disease and, with appropriate preanalytics, provides the test of choice. Measurements of methoxytyramine in urine show limited diagnostic utility compared with plasma.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | | | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christina Pamporaki
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Jimmy Masjkur
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Natalie Rogowski-Lehmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katharina Langton
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Elena Tsourdi
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
- Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | | | - Stephanie Fliedner
- First Department of Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard Sinnott
- Department of Computing and Information, University of Melbourne, Melbourne, Australia
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Central Laboratory, University Hospital, University of Würzburg, Würzburg, Germany
| | | | - Jacques W M Lenders
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Moya L, Moreno J, Lombo M, Guerrero C, Aristizábal D, Vera A, Melgarejo E, Conta J, Gómez C, Valenzuela D, Ángel M, Achury H, Duque R, Triana Á, Gelves J, Pinzón A, Caicedo A, Cuéllar C, Sandoval J, Pérez J, Rico-Mendoza A, Porras-Ramírez A. Consenso de expertos sobre el manejo clínico de la hipertensión arterial en Colombia. Sociedad Colombiana de Cardiología y Cirugía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Khattak S, Sim I, Dancy L, Whitelaw B, Sado D. Phaeochromocytoma found on cardiovascular magnetic resonance in a patient presenting with acute myocarditis: an unusual association. BMJ Case Rep 2018; 2018:bcr-2017-222621. [PMID: 29884661 DOI: 10.1136/bcr-2017-222621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Myocarditis is inflammation of the cardiac muscle. The symptoms, signs and basic investigation findings can mimic that of myocardial infarction. The most common cause is infection (most commonly viral). Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive diagnostic test for potential acute myocarditis as it allows assessment of myocardial oedema and scar. A man aged 25 years was admitted with chest pain, dizziness, headache, palpitations and sweating. His troponin was mildly positive. A CMR was performed which showed mild myocarditis and a right suprarenal mass which was confirmed to be a phaeochromocytoma based on biochemistry and a dedicated imaging workup. Phaeochromocytoma can lead to cardiac involvement in the form of left ventricular dysfunction, or catecholamine-induced myocarditis.
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Affiliation(s)
- Sophia Khattak
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Iain Sim
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Luke Dancy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Benjamin Whitelaw
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dan Sado
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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16
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Kim J, Ro SK, Kim JB, Jung SH, Chung CH, Lee JW, Choo SJ. Remnant aortic remodelling in younger patients after acute type I aortic dissection surgery. Eur J Cardiothorac Surg 2018; 52:150-155. [PMID: 28398536 DOI: 10.1093/ejcts/ezx057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/31/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the influence of age on remnant aortic remodelling after acute DeBakey type I aortic dissection (AD) surgery. METHODS Between January 1999 and December 2013, 118 acute type I AD patients (26 aged <50 years, Group A; 92 aged ≥ 50 years, Group B) with either ascending or ascending hemiarch replacement in whom preoperative and >1-month postoperative chest computed tomography (CT) were available were included. RESULTS At median CT follow-up of 35.1 (interquartile range, 14.1-65.2) months, the aortic dimensions in Group A increased significantly from the baseline values at the root, arch and descending thoracic aorta levels at 40.8 ± 5.3 mm to 43.1 ± 6.5 mm ( P = 0.010), 36.8 ± 7.1 mm to 40.7 ± 8.8 mm ( P = 0.043) and 36.7 ± 6.8 mm to 42.8 ± 11.4 mm ( P = 0.009), respectively. In Group B, only the descending thoracic aorta had increased significantly from the baseline at 37.8 ± 4.8 mm to 40.7 ± 9.4 mm ( P = 0.002). Linear regression analysis showed a significant correlation between younger age and aortic size increase, especially at the aortic sinus level. No significant between-group differences in mortality and reoperation rates were seen during the follow-up of 45.0 ± 33.6 months vs 44.1 ± 31.7 months, respectively. CONCLUSIONS A significantly greater tendency for the remnant aorta to undergo more rapid and generalized adverse remodelling was seen in younger patients after acute type I AD surgery.
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Affiliation(s)
- Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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17
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Sohawon R, Truran P, Webster J, Harrison BJ, Balasubramanian SP. Optimal Management of a Synchronous Diagnosis of Phaeochromocytoma and Colorectal Neoplasia. Indian J Surg Oncol 2017; 8:622-626. [PMID: 29203998 DOI: 10.1007/s13193-017-0627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/13/2017] [Indexed: 11/25/2022] Open
Abstract
The incidence rates of phaeochromocytoma and colorectal cancer (CRC) are approximately 1 and 65 per 100,000 per year, respectively. Simultaneous presentation of these conditions is rare and poses unique management challenges. We report on treatment strategies and clinical outcomes in a series of patients with colorectal neoplasia and phaeochromocytoma. Demographic and clinical details of four patients over a 4-year period were reviewed. The median (range) age at first presentation was 66 (52-70) years. Phaeochromocytoma (2.5-12.5 cm) was confirmed on biochemistry after incidental detection of an adrenal mass on CT scan-three had CT for staging of CRC and one had CT scan for weight loss. Adrenalectomy (three retroperitoneoscopic and one open procedure) was first performed after maximally tolerated alpha blockade; no significant complications were observed. Normalisation of biochemistry was confirmed and the patients then underwent colorectal surgery-laparoscopic right hemicolectomy, open right hemicolectomy (with further extensive surgery) for locally advanced cancer, laparoscopic low anterior resection and open high anterior resection. One respiratory infection and a seroma were the post-operative complications seen. In patients with a simultaneous diagnosis of phaeochromocytoma and CRC, surgical interventions should be staged. Adrenalectomy should first be performed to avoid haemodynamic instability during colorectal resection. A retroperitoneoscopic approach to the adrenal in patients with ipsilateral colonic tumours avoids transgressing the planes for colorectal resection. The synchronous diagnosis of these two rare conditions and the reported stimulatory effect of catecholamines on colorectal epithelia raise the possibility of an increased incidence of colorectal neoplasia in patients with phaeochromocytoma.
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Affiliation(s)
- Ridwaan Sohawon
- University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Peter Truran
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Webster
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Sabapathy P Balasubramanian
- University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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19
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Abstract
The advent of mass spectrometry into the clinical laboratory has led to an improvement in clinical management of several endocrine diseases. Liquid chromatography tandem mass spectrometry found some of its first clinical applications in the diagnosis of inborn errors of metabolism, in quantitative steroid analysis, and in drug analysis laboratories. Mass spectrometry assays offer analytical sensitivity and specificity that is superior to immunoassays for many analytes. This article highlights several areas of clinical endocrinology that have witnessed the use of liquid chromatography tandem mass spectrometry to improve clinical outcomes.
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Affiliation(s)
- Siva S Ketha
- Department of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - Ravinder J Singh
- Department of Pathology and Laboratory Medicine, Mayo Clinic, 200 2nd Street, Rochester, MN, 55905, USA
| | - Hemamalini Ketha
- Department of Pathology, University Hospital, University of Michigan Hospital and Health Systems, 1500 East Medical Center Drive, Room 2F432, Ann Arbor, MI, 48109, USA.
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20
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Naghshineh E, Shahraki AD, Sheikhalian S, Hashemi L. Pheochromocytoma after Cesarean Section. Int J Prev Med 2016; 7:60. [PMID: 27076898 PMCID: PMC4809121 DOI: 10.4103/2008-7802.178534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/16/2016] [Indexed: 11/09/2022] Open
Abstract
Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy.
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Affiliation(s)
- Elham Naghshineh
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Danesh Shahraki
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaye Sheikhalian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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21
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Barrett C, van Uum SHM, Lenders JWM. Risk of catecholaminergic crisis following glucocorticoid administration in patients with an adrenal mass: a literature review. Clin Endocrinol (Oxf) 2015; 83:622-8. [PMID: 25940577 DOI: 10.1111/cen.12813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/12/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Glucocorticoids as diagnostic or therapeutic agents have been reported to carry an increased risk of catecholaminergic crisis (CC) in patients with pheochromocytoma or paraganglioma (PPGL). METHODS We searched literature databases using the following terms: pheochromocytoma, paraganglioma, adrenal incidentaloma, steroids, glucocorticoids, dexamethasone suppression test (DST), hypertensive crisis, cosyntropin and CRH. From all published case reports (1962-2013), we reviewed medical history, presenting symptoms, dose and route of steroid administration, location and size of adrenal mass, biochemical phenotype and outcome. RESULTS Twenty-five case reports describing a CC were identified. Three patients with an adrenal incidentaloma suffered a CC following high-dose DST, and in one case, this was fatal. In two of these patients, biochemical testing missed the diagnosis, and in the third, a DST was done despite elevated urinary metanephrines. No CC has been reported for patients undergoing a low-dose DST. Three of 16 patients who received therapeutic glucocorticoids and four of six patients following cosyntropin testing died. No specific biochemical phenotype was related to adverse events. CONCLUSIONS Although a causal relationship cannot be established from this review, it seems prudent to exclude a PPGL in patients with a large incidentaloma or when high-dose DST is considered in a patient with an incidentaloma of any size. Our literature review does not support the need for biochemical testing for PPGL prior to a low-dose (1 mg) DST. Finally, before starting therapeutic glucocorticoids, any clinical signs or symptoms of a potential PPGL should prompt reliable biochemical testing to rule out a PPGL.
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Affiliation(s)
- Catherine Barrett
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stan H M van Uum
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jacques W M Lenders
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Brito JP, Asi N, Gionfriddo MR, Norman C, Leppin AL, Zeballos-Palacios C, Undavalli C, Wang Z, Domecq JP, Prustsky G, Elraiyah TA, Prokop LJ, Montori VM, Murad MH. The incremental benefit of functional imaging in pheochromocytoma/paraganglioma: a systematic review. Endocrine 2015; 50:176-86. [PMID: 25663601 DOI: 10.1007/s12020-015-0544-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/27/2015] [Indexed: 01/04/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) are the major imaging modalities used for the localization of catecholamine-producing tumors (pheochromocytoma and paraganglioma). Functional imaging (FI) offers an alternative approach to localize, evaluate, and stage these tumors. Our objective was to describe the additive benefit of FI studies for patients with pheochromocytoma and paraganglioma (PPG) who have undergone MRI or CT scan evaluation. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from database inception through June 2012 for studies that included patients with biochemically proven PPGs who underwent CT or MRI and additional FI for the localization of PPGs. We included 32 studies enrolling a total of 1,264 patients with a mean age of 43-years old. The studies were uncontrolled and evaluated six FI modalities. FI tests provided small additive value to CT/MRI, aiding in the localization of only 24/1,445 primary cases (1.4 %) and 28/805 metastatic cases (3.5 %). In metastatic cases, 6-[F-18]fluoro-L-dihydroxyphenylalanine (DOPA) and fluorodopamine-PET (FDA) were the FI tests most successful at identifying disease missed by CT/MRI, providing additional benefit in 6/60 (10 %) and 5/78 (6.4 %) cases, respectively. No clinically significant findings were observed in any of the predefined subgroups. No study evaluated the impact of FI on the completeness of surgical resection or other patient-important outcomes. Observational evidence suggests that FI tests have a limited additional role in patients with PPGs who have undergone CT/MRI evaluation. However, the role of FI tests in specific subgroups of patients with atypical presentations (metastatic, extra-adrenal) as well as the use of hybrid FI tests should be explored. Further research should also evaluate the impact of FI tests on patient-important outcomes.
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Affiliation(s)
- Juan P Brito
- Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
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23
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Abstract
Adrenal diseases, including Cushing syndrome (CS), primary aldosteronism (PA), pheochromocytoma, and adrenocortical carcinoma, are uncommon in pregnancy; a high degree of clinical suspicion must exist. Physiologic changes to the hypothalamus-pituitary-adrenal axis in a normal pregnancy result in increased cortisol, renin, and aldosterone levels, making the diagnosis of CS and PA in pregnancy challenging. However, catecholamines are not altered in pregnancy and allow a laboratory diagnosis of pheochromocytoma that is similar to that of the nonpregnant state. Although adrenal tumors in pregnancy result in significant maternal and fetal morbidity, and sometimes mortality, early diagnosis and appropriate treatment often improve outcomes.
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Affiliation(s)
- Deirdre Cocks Eschler
- Endocrinology Division, Department of Medicine, Stony Brook University School of Medicine, HSC T15-060, Stony Brook, NY 11794, USA.
| | - Nina Kogekar
- Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Rachel Pessah-Pollack
- Endocrinology Division, Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA; Department of Endocrinology, ProHealth Care Associates, Ohio Drive, Lake Success, NY 11042, USA
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24
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Abstract
Elevated blood pressure (BP) is a common problem in patients hospitalized for reasons other than hypertension. Unexpected elevations commonly result in calls to physicians who too often prescribe medication to reduce the numbers without evaluating the patient or determining the cause of the elevation. This may result in unnecessary and sometimes harmful treatment. Such BP elevation has many potential causes. These include anxiety, post-operative salt and volume overload, failure to administer the patient's known antihypertensive medication, inability to give oral antihypertensive medication to patients who cannot take pills by mouth, incipient heart failure, previously unrecognized renal failure, obstructive uropathy and other causes. These must be identified and treated prior to addressing only the elevated BP numbers. We present an algorithm for evaluating hospitalized patients with elevated BP in order to assist physicians in identifying the true cause of the elevation, treating the identified cause, and giving appropriate drug treatment. We also note that this is a golden opportunity for communication with the outpatient providers who will follow the patient.
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Affiliation(s)
- Win Myint Aung
- Department of Medicine, Division of Hospital Medicine, Miller School of Medicine, University of Miami , Miami, FL , USA
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25
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Brito JP, Asi N, Bancos I, Gionfriddo MR, Zeballos-Palacios CL, Leppin AL, Undavalli C, Wang Z, Domecq JP, Prustsky G, Elraiyah TA, Prokop LJ, Montori VM, Murad MH. Testing for germline mutations in sporadic pheochromocytoma/paraganglioma: a systematic review. Clin Endocrinol (Oxf) 2015; 82:338-45. [PMID: 24954084 DOI: 10.1111/cen.12530] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 06/14/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The presence of germline mutations in sporadic pheochromocytomas and paragangliomas (SPPs) may change the clinical management of both index patients and their family members. However, the frequency of germline mutations in SPPs is unknown. OBJECTIVE To describe the frequency of germline mutations in SPPs and to determine the value of testing index patients and their family members for these mutations. METHODS We searched databases through June 2012 for observational studies of patients with SPPs who underwent germline genetic testing. The criteria used to define sporadic tumours were (i) the absence of a family history of PCC/PG, (ii) the absence of syndromic features, (iii) the absence of bilateral disease and (iv) the absence of metastatic disease. RESULTS We included 31 studies including 5031 patients (mean age 44). These patients received tests for any of these ten mutations: SDHAF2, RET, SDHD, SDHB, SDHC, VHL, TMEM127, MAX, Isocitrate Dehydrogenase Mutation (IDH) and NF1. The overall frequency of germline mutation in SPP was 551 of 5031 or 11%; when studies with patients fulfilling four criteria for sporadic tumours were used, the frequency was 171 of 1332 or 13%. The most common germline mutation was SDHB 167 of 3611 (4·6%). Little outcome data were available to assess the benefits of genetic testing in index cases and family members. CONCLUSIONS The frequency of germline mutations in SPPs is approximately 11-13% and the most common mutations affect less than 1 in 20 patients. The value of testing for germline mutations in patients with SPPs and their family members is unknown, as the balance of potential benefits and harms remains unclear.
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Affiliation(s)
- Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Costa MHS, Ortiga-Carvalho TM, Violante AD, Vaisman M. Pheochromocytomas and Paragangliomas: Clinical and Genetic Approaches. Front Endocrinol (Lausanne) 2015; 6:126. [PMID: 26347711 PMCID: PMC4538298 DOI: 10.3389/fendo.2015.00126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/27/2015] [Indexed: 12/27/2022] Open
Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs) are neuroendocrine tumors derived from the chromaffin tissue. Diagnosis of these tumors is extremely important as they are linked to the hypertension syndrome with great cardiovascular morbidity and mortality. A great majority of PCCs and PGLs are sporadic and benign tumors; however, the classic idea of 10% exception of these features is changing. The description of new genes linked to familial forms of PCC/PGLs, such as succinate dehydrogenase (SDH) complex subunits, KIF1Bβ, EGLN1, TMEM127, and MAX, added to the well-known PCC familial syndrome (MEN2, VHL, and neurofibromatosis type 1) presents new challenges for diagnosis. In this review, we discuss the diversity of clinical and genetic approaches to this syndrome as well the diverse criteria that should guide genetic investigation.
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Affiliation(s)
| | - Tania M. Ortiga-Carvalho
- Laboratory of Translational Endocrinology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alice Dutra Violante
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Vaisman
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Mario Vaisman, Serviço de Endocrinologia, HUCFF, Rua Rodolpho Paulo Rocco, 255 Cidade Universitária, Rio de Janeiro, RJ CEP 21941-913, Brazil,
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Affiliation(s)
- Neelam H Shah
- From the Department of Medicine (N.H.S.) and the Endocrine Surgical Unit (D.T.R.), Brigham & Women's Hospital, Boston, MA; the Department of Medicine, Boston Children's Hospital, Boston, MA (N.H.S.); and the Department of Pediatrics, Boston Medical Center, Boston, MA (N.H.S.)
| | - Daniel T Ruan
- From the Department of Medicine (N.H.S.) and the Endocrine Surgical Unit (D.T.R.), Brigham & Women's Hospital, Boston, MA; the Department of Medicine, Boston Children's Hospital, Boston, MA (N.H.S.); and the Department of Pediatrics, Boston Medical Center, Boston, MA (N.H.S.).
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Abstract
Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects ∼5-10% of the general hypertensive population. Because secondary forms are rare and work up is time-consuming and expensive, only patients with clinical suspicion should be screened. In recent years, some new aspects gained importance regarding this screening. In particular, increasing evidence suggests that 24 h ambulatory blood pressure (BP) monitoring plays a central role in the work up of patients with suspected secondary hypertension. Moreover, obstructive sleep apnoea has been identified as one of the most frequent causes. Finally, the introduction of catheter-based renal denervation for the treatment of patients with resistant hypertension has dramatically increased the interest and the number of patients evaluated for renal artery stenosis. We review the clinical clues of the most common causes of secondary hypertension. Specific recommendations are given as to evaluation and treatment of various forms of secondary hypertension. Despite appropriate therapy or even removal of the secondary cause, BP rarely ever returns to normal with long-term follow-up. Such residue hypertension indicates either that some patients with secondary hypertension also have concomitant essential hypertension or that irreversible vascular remodelling has taken place. Thus, in patients with potentially reversible causes of hypertension, early detection and treatment are important to minimize/prevent irreversible changes in the vasculature and target organs.
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Affiliation(s)
- Stefano F Rimoldi
- Department of Cardiology, Inselspital, University Hospital, Bern, Switzerland
| | - Urs Scherrer
- Department of Cardiology, Inselspital, University Hospital, Bern, Switzerland Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile
| | - Franz H Messerli
- Division of Cardiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
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Bi C, Li B, Du L, Wang L, Zhang Y, Cheng Z, Zhai A. Vitamin D receptor, an important transcription factor associated with aldosterone-producing adenoma. PLoS One 2013; 8:e82309. [PMID: 24376526 PMCID: PMC3869669 DOI: 10.1371/journal.pone.0082309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/22/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To explore the endocrine mechanisms of aldosterone-producing adenoma (APA) by using the microarray expression profiles of normal and APA samples. METHODS The gene expression profile GSE8514 was downloaded from Gene Expression Omnibus database, including samples from normal adrenals (n = 5) and APAs (n = 10). The differentially expressed genes (DEGs) were identified by samr package and endocrine DEGs were obtained according to Clinical Genome Database. Then, functional enrichment analysis of screened DEGs was performed by DAVID (Database for Annotation, Visualization and Integrated Discovery). Finally, a regulatory network was constructed to screen endocrine genes related with adrenal dysfunction and pathway enrichment analysis for the constructed network was performed. RESULTS A total of 2149 DEGs were identified including 379 up- and 1770 down-regulated genes. And 26 endocrine genes were filtered from the DEGs. Furthermore, the down-regulated DEGs are mainly related to protein kinase cascade, response to molecule of bacterial origin, response to lipopolysaccharide, cellular macromolecule catabolic process and macromolecule catabolic process, while the up-regulated DEGs are related with regulation of ion transport. The target genes of VDR (vitamin D receptor), one of the three endocrine genes differentially expressed in the regulatory network, were endocrine genes including CYP24A1 (25-hydroxyvitamin D-24-hydroxylase) and PTH (parathyroid hormone). Three pathways may be associated with APA pathogenesis including cytokine-cytokine receptor interaction, pathways in cancer and autoimmune thyroid disease. CONCLUSION The VDR is the most significant transcription factor and related endocrine genes might play important roles in the endocrine mechanisms of APA.
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Affiliation(s)
- Changlong Bi
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Li
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Du
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lishan Wang
- FengHe (ShangHai) Information Technology Co., Ltd., Shanghai, China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai ,China
| | - Yingqi Zhang
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhifeng Cheng
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Aixia Zhai
- Department of Microbiology, Harbin Medical University, Harbin, China
- Heilongjiang Provincial Science and Technology Innovation Team in Higher Education Institutes for Infection and Immunity, Harbin Medical University, Harbin , China
- Heilongjiang Provincial Key Laboratory for Infection and Immunity, Harbin Medical University, Harbin, China
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Fhaner MJ, Galligan JJ, Swain GM. Increased catecholamine secretion from single adrenal chromaffin cells in DOCA-salt hypertension is associated with potassium channel dysfunction. ACS Chem Neurosci 2013; 4:1404-13. [PMID: 23937098 DOI: 10.1021/cn400115v] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The mechanism of catecholamine release from single adrenal chromaffin cells isolated from normotensive and DOCA-salt hypertensive rats was investigated. These cells were used as a model for sympathetic nerves to better understand how exocytotic release of catecholamines is altered in this model of hypertension. Catecholamine secretion was evoked by local application of acetylcholine (1 mM) or high K+ (70 mM), and continuous amperometry was used to monitor catecholamine secretion as an oxidative current. The total number of catecholamine molecules secreted from a vesicle, the total number of vesicles fusing and secreting, and the duration of secretion in response to a stimulus were all significantly greater for chromaffin cells from hypertensive rats as compared to normotensive controls. The greater catecholamine secretion from DOCA-salt cells results, at least in part, from functionally impaired large conductance, Ca2+-activated (BK) and ATP-sensitive K+ channels. This work reveals that there is altered vesicular release of catecholamines from these cells (and possibly from perivascular sympathetic nerves) and this may contribute to increased vasomotor tone in DOCA-salt hypertension.
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Affiliation(s)
- Matthew J. Fhaner
- Department of Chemistry, ‡Department of Pharmacology and Toxicology, and §The Neuroscience
Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - James J. Galligan
- Department of Chemistry, ‡Department of Pharmacology and Toxicology, and §The Neuroscience
Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - Greg M. Swain
- Department of Chemistry, ‡Department of Pharmacology and Toxicology, and §The Neuroscience
Program, Michigan State University, East Lansing, Michigan 48824, United States
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Cabassi A, Rocco R, Berretta R, Regolisti G, Bacchi-Modena A. Eplerenone Use in Primary Aldosteronism During Pregnancy. Hypertension 2012; 59:e18-9. [DOI: 10.1161/hypertensionaha.111.187237] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Rossana Rocco
- Department of Internal Medicine, Nephrology, and Health Sciences Hypertension Unit Azienda Ospedaliera Universitaria di Parma Parma, Italy (Cabassi, Rocco)
| | - Roberto Berretta
- Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria di Parma Parma, Italy (Berretta)
| | - Giuseppe Regolisti
- Department of Internal Medicine, Nephrology, and Health Sciences Hypertension Unit Azienda Ospedaliera Universitaria di Parma Parma, Italy (Regolisti)
| | - Alberto Bacchi-Modena
- Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria di Parma Parma, Italy (Bacchi-Modena)
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Macfarlane DP, Leese GP. Hypoglycaemia, phaeochromocytoma and features of acromegaly: a unifying diagnosis? QJM 2011; 104:983-6. [PMID: 21075788 DOI: 10.1093/qjmed/hcq219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- D P Macfarlane
- Department of Diabetes, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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Zelinka T, Musil Z, Dušková J, Burton D, Merino MJ, Milosevic D, Widimský J, Pacak K. Metastatic pheochromocytoma: does the size and age matter? Eur J Clin Invest 2011; 41:1121-8. [PMID: 21692797 PMCID: PMC3170415 DOI: 10.1111/j.1365-2362.2011.02518.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pheochromocytomas are tumours arising from chromaffin tissue located in the adrenal medulla associated with typical symptoms and signs which may occasionally develop metastases, which are defined as the presence of tumour cells at sites where these cells are not found. This retrospective analysis was focused on clinical, genetic and histopathologic characteristics of primary metastatic versus primary benign pheochromocytomas. MATERIALS AND METHODS We identified 41 subjects with metastatic pheochromocytoma and 108 subjects with apparently benign pheochromocytoma. We assessed dimension and biochemical profile of the primary tumour, age at presentation and time to develop metastases. RESULTS Subjects with metastatic pheochromocytoma presented at a significantly younger age (41·4 ± 14·7 vs. 50·2 ± 13·7 years; P < 0·001) with larger primary tumours (8·38 ± 3·27 vs. 6·18 ± 2·75 cm; P < 0·001) and secreted more frequently norepinephrine (95·1% vs. 83·3%; P = 0·046) compared to subjects with apparently benign pheochromocytomas. No significant differences were found in the incidence of genetic mutations in both groups of subjects (25·7% in the metastatic group and 14·7% in the benign group; P = 0·13). From available histopathologic markers of potential malignancy, only necrosis occurred more frequently in subjects with metastatic pheochromocytoma (27·6% vs. 0%; P < 0·001). The median time to develop metastases was 3·6 years with the longest interval 24 years. CONCLUSIONS In conclusion, regardless of a genetic background, the size of a primary pheochromocytoma and age of its first presentation are two independent risk factors associated with the development of metastatic disease.
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Affiliation(s)
- Tomáš Zelinka
- 3rd Department of Medicine, Department of Endocrinology and Metabolism, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Abstract
Primary aldosteronism is the most common form of secondary hypertension. The detection of primary aldosteronism is of particular importance, not only because it provides an opportunity for a targeted treatment (surgical for APA and medical with mineralocorticoid receptor antagonists for BAH), but also because it has been extensively demonstrated that patients affected by PA are more prone to cardiovascular events and target organ damage than essential hypertensives. According to the Endocrine Society Guidelines diagnosis of PA is made following a rigorous flow-chart comprising screening, confirmation/exclusion testing and subtype diagnosis. In the present review we describe briefly the published diagnostic strategies of the Guidelines, highlighting new evidence that has become recently available and discuss issues that still need to be addressed by future research.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medicine and Experimental Oncology, University of Torino, 10126, Torino, Italy.
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Rhee SS, Pearce EN. Update: Systemic Diseases and the Cardiovascular System (II). The endocrine system and the heart: a review. Rev Esp Cardiol 2011. [PMID: 21330038 DOI: 10.1016/j.rec.2010.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Normal endocrine function is essential for cardiovascular health. Disorders of the endocrine system, consisting of hormone hyperfunction and hypofunction, have multiple effects on the cardiovascular system. In this review, we discuss the epidemiology, diagnosis, and management of disorders of the pituitary, thyroid, parathyroid, and adrenal glands, with respect to the impact of endocrine dysfunction on the cardiovascular system. We also review the cardiovascular benefits of restoring normal endocrine function.
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Affiliation(s)
- Soo S Rhee
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Primary aldosteronism (PA) is an important cause of secondary hypertension, is being increasingly diagnosed and may account for more than 10% of hypertensive patients, both in primary care and in referral centers. Aldosterone excess is associated with adverse cardiovascular, renal and metabolic effects that are in part hypertension-independent. Laparoscopic adrenalectomy remains the mainstay of treatment for unilateral forms of PA, whereas medical treatment is recommended for bilateral forms of PA. However, a favourable surgical outcome depends on several factors and many patients are not suitable for this treatment. On the other hand, surgery in patients considered to have bilateral PA may contribute to better blood pressure control. In this review, established and novel strategies for the management of different types of PA are discussed.
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Affiliation(s)
- Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, 44, Tsimiski str., Thessaloniki, 54623, Greece.
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Rhee SS, Pearce EN. Update: Systemic Diseases and the Cardiovascular System (II). The endocrine system and the heart: a review. Rev Esp Cardiol 2011; 64:220-31. [PMID: 21330038 DOI: 10.1016/j.recesp.2010.10.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/05/2010] [Indexed: 02/09/2023]
Abstract
Normal endocrine function is essential for cardiovascular health. Disorders of the endocrine system, consisting of hormone hyperfunction and hypofunction, have multiple effects on the cardiovascular system. In this review, we discuss the epidemiology, diagnosis, and management of disorders of the pituitary, thyroid, parathyroid, and adrenal glands, with respect to the impact of endocrine dysfunction on the cardiovascular system. We also review the cardiovascular benefits of restoring normal endocrine function.
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Affiliation(s)
- Soo S Rhee
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
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Fernandes GH, Silva Júnior GB, Garcia JHP, Sobrinho CRM, Albuquerque PLMM, Libório AB, Daher EF. Delayed diagnosis of pheochromocytoma associated with chronic kidney disease. Indian J Nephrol 2010; 20:166-7. [PMID: 21072160 PMCID: PMC2966986 DOI: 10.4103/0971-4065.70843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pheochromocytoma is a rare disease charactrized by excessive production of catecholamines, manifestating mainly with hypertension. We report the case of a 45-year-old woman with history of sudden onset dyspnea, headache, palpitations and sudoresis. An abdominal ultrasound was suggestive of chronic kidney disease (CKD). An abdominal computed tomography and magnetic resonance was performed and showed a mass in the topography of left adrenal. The patient underwent a surgery for the removal of the mass and became stable with normal blood pressure levels, but remained with CKD. The dalayed diagnosis of pheochromocytoma in the present case has contributed to the development of CKD.
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Affiliation(s)
- G H Fernandes
- Divisions of Nephrology and Cardiology, Hospital Universitário Walter Cantídio, School of Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Abstract
Unsuspected adrenal masses, or incidentalomas, are increasingly found with the widespread use of thoracic and abdominal imaging. These masses may be hormonally active or nonfunctional and malignant or benign. Clinicians must determine the nature of the mass to decide what treatment, if any, is needed. Measurement of precontrast Hounsfield units (HU) and contrast washout on computed tomography scan provide useful diagnostic information. All patients should undergo biochemical testing for pheochromocytoma, either with plasma or urinary catecholamine measurements. This is particularly important before surgical resection, which is routinely recommended for masses larger than 4 cm in diameter without a clear-cut diagnosis and for others with hormonal secretion or ominous imaging characteristics. Hypertensive patients should undergo biochemical testing for hyperaldosteronism. Patients with features consistent with Cushing's syndrome, such as glucose intolerance, weight gain, and unexplained osteopenia, should be evaluated for cortisol excess. Here, the dexamethasone suppression test and late-night salivary cortisol may be preferred over measurement of urine cortisol. The ability of surgical resection to reverse features of mild hypercortisolism is not well established. For masses that appear to be benign (<10 HU; washout, >50%), small (<3 cm), and completely nonfunctioning, imaging and biochemical reevaluation (pheochromocytoma and hypercortisolism only) at 1-2 yr (or more) is appropriate. For more indeterminate lesions, repeat evaluation for growth after 3-12 months is useful, with subsequent testing intervals based on the rate of growth.
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Affiliation(s)
- Lynnette K Nieman
- Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1109, USA.
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Carey M, Carter J, Nesbitt I. Phaeochromocytoma Crisis Presenting under Anaesthesia with Profound Left Ventricular Failure — Successful Treatment with Intra-Aortic Balloon Pump. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A patient presented with a phaeochromocytoma crisis during routine anaesthesia for minor ENT surgery. The ensuing cardiac arrest and profound left ventricular failure were successfully treated with an intra-aortic balloon pump until alpha blockade with phenoxybenzamine took effect. The rapid diagnosis of phaeochromocytoma and management of phaeochromocytoma crisis are reviewed.
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Affiliation(s)
- Michelle Carey
- Michelle Carey Consultant in Anaesthesia and Intensive Care Medicine, The James Cook University Hospital, Middlesbrough
| | - Jim Carter
- Jim Carter Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne
| | - Ian Nesbitt
- Ian Nesbitt Consultant in Anaesthesia and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne
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Mulatero P, Monticone S, Bertello C, Tizzani D, Iannaccone A, Crudo V, Veglio F. Evaluation of primary aldosteronism. Curr Opin Endocrinol Diabetes Obes 2010; 17:188-93. [PMID: 20389241 DOI: 10.1097/med.0b013e3283390f8d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to briefly summarize current knowledge on diagnosis and treatment of primary aldosteronism, the most frequent cause of endocrine hypertension. RECENT FINDINGS The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. The detection of primary aldosteronism is of particular importance, not only because it provides an opportunity for a targeted treatment but also because it has been extensively demonstrated that patients affected by primary aldosteronism are more prone to cardiovascular events and target organ damage than patients with essential hypertension. The diagnosis of primary aldosteronism is a three-step process; screening, confirmation and subtype diagnosis. SUMMARY We review, the strategies to correctly identify primary aldosteronism, highlighting the central role of the new guidelines and the diagnostic aspects still under debate.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy.
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Carty D, Crichton L, Alakandy L, O’Dwyer P, Dominiczak A. Hypertension in pregnancy: think laterally. Eur J Obstet Gynecol Reprod Biol 2010; 150:220-1. [DOI: 10.1016/j.ejogrb.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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de Jong WH, de Vries EG, Wolffenbuttel BH, Kema I. Automated mass spectrometric analysis of urinary free catecholamines using on-line solid phase extraction. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:1506-12. [DOI: 10.1016/j.jchromb.2010.03.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/19/2010] [Accepted: 03/31/2010] [Indexed: 11/27/2022]
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Affiliation(s)
- Raymond Oliva
- From the Department of Medicine (R.O., G.B.), Hypertension Diseases Unit, Section of Endocrinology, Diabetes, Metabolism, and Hypertension, and Department of Surgery (P.A., E.K.), University of Chicago Medical Center, Chicago, Ill
| | - Peter Angelos
- From the Department of Medicine (R.O., G.B.), Hypertension Diseases Unit, Section of Endocrinology, Diabetes, Metabolism, and Hypertension, and Department of Surgery (P.A., E.K.), University of Chicago Medical Center, Chicago, Ill
| | - Edwin Kaplan
- From the Department of Medicine (R.O., G.B.), Hypertension Diseases Unit, Section of Endocrinology, Diabetes, Metabolism, and Hypertension, and Department of Surgery (P.A., E.K.), University of Chicago Medical Center, Chicago, Ill
| | - George Bakris
- From the Department of Medicine (R.O., G.B.), Hypertension Diseases Unit, Section of Endocrinology, Diabetes, Metabolism, and Hypertension, and Department of Surgery (P.A., E.K.), University of Chicago Medical Center, Chicago, Ill
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Pérez Unanua M, Muñoz González Y, Mateo Pascual C, García García A. Manejo de la patología suprarrenal en Atención Primaria. Semergen 2010. [DOI: 10.1016/j.semerg.2009.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hanna-Moussa A, Kurukulasuriya LR, Sowers JR. Malignant Pheochromocytoma Presenting With Uncontrolled Hypertension After Kidney Transplant. J Clin Hypertens (Greenwich) 2010; 12:105-8. [DOI: 10.1111/j.1751-7176.2009.00221.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Oh MK. Secondary Hypertension. Korean J Fam Med 2010. [DOI: 10.4082/kjfm.2010.31.6.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mi-Kyeong Oh
- Department of Family Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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50
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Think, diagnose, and rethink. Am J Med 2009; 122:823-6. [PMID: 19699375 DOI: 10.1016/j.amjmed.2009.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/27/2009] [Accepted: 05/27/2009] [Indexed: 11/21/2022]
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