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Paz-López AJ, Rafael-Pérez CI, Llanos-Salas BA, Castañeda-Anaya PS, Gómez-Arenas SR, Nacud-Bezies YA. Detection and Surgical Approach to Pheochromocytoma: A Case Report. Cureus 2024; 16:e55504. [PMID: 38571831 PMCID: PMC10990478 DOI: 10.7759/cureus.55504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Pheochromocytomas are neuroendocrine tumors that produce, store, and secrete catecholamines. They are found in the chromaffin tissue of the adrenal medulla and manifest clinical symptoms by producing an excessive amount of one or more catecholamines, such as dopamine, adrenaline, and noradrenaline, as well as their inactive metabolites, such as metanephrine, normetanephrine, and 3-methoxytyramine. This paper is the case report of a 53-year-old male patient with diabetes and hypertension who has been experiencing symptoms such as night sweats, frequent colds, weight loss, reduced appetite, and generalized anxiety. The patient presented with pelvic pain and sought medical attention, leading to an abdominal MRI scan that revealed a right adrenal mass. The patient's plasma metanephrine levels were found to be four-fold higher than the normal range. A contrast CT scan of the abdomen and pelvis revealed a right adrenal gland with increased dimensions and well-defined edges. A diagnosis of right adrenal pheochromocytoma was made. The patient underwent a right laparoscopic adrenalectomy, which resulted in a reduction in metanephrine levels and normal blood pressure readings. The patient presented a favorable clinical evolution in the post-surgical period, for which it was decided to be discharged home.
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Affiliation(s)
- Alexis Jared Paz-López
- Departamento de cirugía digestiva y endocrina, Unidad Médica de Alta Especialidad No. 25, Monterrey, MEX
| | | | - Brenda Aurora Llanos-Salas
- Departamento de cirugía digestiva y endocrina, Unidad Médica de Alta Especialidad No. 25, Monterrey, MEX
| | | | | | - Yamir Ahmed Nacud-Bezies
- Departamento de cirugía digestiva y endocrina, Unidad Médica de Alta Especialidad No. 25, Monterrey, MEX
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Abdullah AM, Kakamad FH, Tahir SH, Muhialdeen AS, Salih AM, Rahim HM, Mohammed BJ, Abdullah F, Hussein DA, Mohammed SH. Sarcoid‑like granulomatous inflammation in a carotid body paraganglioma: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2023; 3:47. [PMID: 37745149 PMCID: PMC10514569 DOI: 10.3892/mi.2023.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023]
Abstract
Sarcoid-like granulomatous inflammation (SLGI) is defined as the development of non-necrotizing epithelioid granulomas in patients who do not meet the criteria for systemic sarcoidosis. Its occurrence is known to be linked to diverse conditions, including malignancies, infections, the use of certain drugs and inorganic substances. To the best of our knowledge, the available literature to date lacks any description regarding SLGI in a paraganglioma. The present study describes the first case of SLGI in a carotid body paraganglioma (CBP). A 54-year-old female patient presented with anterior neck swelling for 27 years without any other symptoms. An ultrasonography revealed a multinodular goiter with retrosternal extension and a solid lesion on the right side of the neck measuring 40x30x22 mm, which was suggestive of a CBP. The patient underwent a total thyroidectomy, and the right-side cervical mass was resected via another longitudinal incision. A histopathological examination of the thyroid specimen revealed findings of a multinodular goiter. Sections from the right-side cervical mass confirmed the diagnosis of CBP accompanied by multiple, well-formed, small-medium sized, non-necrotizing epithelioid granulomas associated with multinucleated giant cells, indicative of SLGI. Non-necrotizing epithelioid cell granulomas (as with SLGIs), identical to those observed in sarcoidosis, may rarely be observed in patients who do not meet the criteria of systemic sarcoidosis; however, they have been observed in association with various neoplasms. It is thus crucial to distinguish them from actual sarcoidosis, as misdiagnoses may lead to severe consequences. The presence of SLGIs accompanying a paraganglioma is an extremely rare phenomenon. Due to this, it is difficult to conclude if it confers a better prognosis or not.
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Affiliation(s)
- Ari M. Abdullah
- Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46001, Iraq
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
| | - Soran H. Tahir
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Department of Medical Biology, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat 60000, Turkey
| | - Aso S. Muhialdeen
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | - Abdulwahid M. Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
| | - Hawbash M. Rahim
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
- Department of Medical Biology, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat 60000, Turkey
| | - Bruj Jamil Mohammed
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
- Shar Hospital, Department of Medicine, Sulaimani, Kurdistan 46001, Iraq
| | - Fakher Abdullah
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | - Dahat A. Hussein
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
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Patel SP, Jarbath M, Saravis L, Senada P, Lindner DH, Grossman RA, Francosadud RA. Pheochromocytoma manifesting as cortical blindness secondary to PRES with associated TMA: a case report and literature review. BMC Endocr Disord 2022; 22:205. [PMID: 35971105 PMCID: PMC9380330 DOI: 10.1186/s12902-022-01109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pheochromocytomas are neoplasms originating from neuroectodermal chromaffin cells leading to excess catecholamine production. They are notorious for causing a triad of headaches, palpitations, and sweats. Though the Menard triad is one to be vigilant of, symptomatic presentation can vary immensely, hence the tumor earning the label "the great masquerader." CASE PRESENTATION We report a case of pheochromocytoma initially presenting with cortical blindness secondary to posterior reversible encephalopathy syndrome and thrombotic microangiopathy from malignant hypertension. Our patient was seen in our facility less than a week prior to this manifestation and discharged after an unremarkable coronary ischemia work-up. In the outpatient setting, she had been prescribed multiple anti-hypertensives with remarkably elevated blood pressure throughout her hospitalization history. CONCLUSION Pheochromocytoma presenting with malignant hypertension and hypertensive encephalopathy should be expected if left untreated; nonetheless, the precipitation of cortical blindness is rare in the literature. This case contributes an additional vignette to the growing literature revolving adrenal tumors and their symptomatic presentation along with complex management. It also serves to promote increased diagnostic suspicion among clinicians upon evaluating patients with refractory hypertension.
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Affiliation(s)
- Sankalp P Patel
- Department of Graduate Medical Education, Internal Medicine Residency, NCH Healthcare System, Naples, FL, 311 9th St. N34102, USA.
| | - Medjine Jarbath
- Department of Graduate Medical Education, Internal Medicine Residency, NCH Healthcare System, Naples, FL, 311 9th St. N34102, USA
| | - Lauren Saravis
- Department of Graduate Medical Education, Internal Medicine Residency, NCH Healthcare System, Naples, FL, 311 9th St. N34102, USA
| | - Peter Senada
- Department of Graduate Medical Education, Internal Medicine Residency, NCH Healthcare System, Naples, FL, 311 9th St. N34102, USA
| | - David H Lindner
- Department of Pulmonary/Critical Care Medicine, Associate Program Director of Pulmonary/Critical Care Fellowship, NCH Healthcare System, Naples, USA
| | - Robert A Grossman
- Department of General Surgery, General Surgeon, NCH Healthcare System, Naples, USA
| | - Ricardo A Francosadud
- Department of Graduate Medical Education, Associate Program Director of Internal Medicine Residency, NCH Healthcare System, Naples, USA
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Fajardo R, García N, Díaz F. Transperitoneal laparoscopic adrenalectomy for the resection of large size pheochromocytoma: Case report and literature review. Int J Surg Case Rep 2020; 71:353-359. [PMID: 32502952 PMCID: PMC7270531 DOI: 10.1016/j.ijscr.2020.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pheochromocytomas are rare neuroendocrine tumors that form in chromaffin cells of the neural crest during the embryological period. In the overall population, incidence rate is 0.1%; lack of early diagnosis or adequate treatment can lead to life-threatening complications. The secretion of catecholamines, such as adrenaline or norepinephrine, produces paroxysmal headache, palpitations and arterial hypertension. Secondary, hyperglycemic crises may also appear, thus contributing to misdiagnosis of diabetes mellitus or diabetic ketoacidosis. Surgery prevails as primary treatment; despite its subsequent high mortality rate of up to 50% during the intra and postoperative periods. CASE REPORT We describe the case of a 55-year-old man, diagnosed in 2012 with arterial hypertension and almost uncontrollable labile arterial hypertension, who had been medicated with second and third-line antihypertensive drugs, but, who, nonetheless showed no clinical improvement. Biochemical profile studies showed elevated normetanephrine and metanephrine levels; and an abdominal MRI, a markedly vascularized, 72 × 62 mm diameter solid mass in the right adrenal fossa; thereby leading to its classification as a large, noradrenergic phenotype pheochromocytoma. DISCUSSION In 2018, at the Fundación de Santa Fe de Bogotá Hospital, patient underwent Transperitoneal Laparoscopic Adrenalectomy, which proceeded without complications. In the 6-month postoperative follow-up, patient remained asymptomatic for cardiovascular risk and maintained stable blood pressure within goals; consequently, antihypertensive therapy was suspended. CONCLUSION Despite advances in surgical technique and perioperative management, minimally invasive surgery for resection of large pheochromocytoma is a challenging procedure, due to risk of intraoperative hemodynamic instability.
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Affiliation(s)
- Roosevelt Fajardo
- Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia
| | - Nicole García
- Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia.
| | - Francisco Díaz
- Fundación Santa Fe de Bogotá Hospital, General Surgery Department, Cra 7 # 117- 15, Bogota, Colombia
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Abstract
Pheochromocytomas are rare tumors originating in the adrenal medulla. They may be sporadic or in the context of a hereditary syndrome. A considerable number of pheochromocytomas carry germline or somatic gene mutations, which are inherited in the autosomal dominant way. All patients should undergo genetic testing. Symptoms are due to catecholamines over production or to a mass effect. Diagnosis is confirmed by raised plasma or urine metanephrines or normetanephrines. Radiology assists in the tumor location and any local invasion or metastasis. All the patients should have preoperative preparation with α-blockers and/or other medications to control hypertension, arrhythmia, and volume expansion. Surgery is the definitive treatment. Follow up should be life-long.
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Nieto AJ, Trochez L, Ramírez D, Arguello P, Guzman G, Pachajoa H, Escobar Vidarte MF. Paraganglioma in pregnancy: interdisciplinary management during pregnancy. Gynecol Endocrinol 2019; 35:567-570. [PMID: 30786782 DOI: 10.1080/09513590.2019.1576619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Paragangliomas are tumors that originate from the extra-adrenal neural crest, the incidence of which during pregnancy is not more than two to eight cases per million people per year and are known to be highly morbid. The purpose of this report is to describe the experience and results obtained during management of a primigravida diagnosed with paraganglioma on week 21.2 and received both medical and surgical management with good maternal and perinatal outcomes. This case report evidences the importance of practicing interdisciplinary management of patients with clinical suspicion of paragangliomas or pheochromocytomas during pregnancy at high-complexity centers even in a medium-income country.
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Affiliation(s)
- Albaro J Nieto
- a High Complexity Obstetric Unit, Department of Gynecology and Obstetrics , Fundación Valle del Lili , Santiago de Cali , Colombia
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Lizette Trochez
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Daniela Ramírez
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
| | - Pedro Arguello
- c Department of Surgery , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - Guillermo Guzman
- d Department of Endocrinology , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - Harry Pachajoa
- e Department of Genetics , Fundación Valle del Lili , Santiago de Cali , Colombia
| | - María Fernanda Escobar Vidarte
- a High Complexity Obstetric Unit, Department of Gynecology and Obstetrics , Fundación Valle del Lili , Santiago de Cali , Colombia
- b Department of Health Sciences, Faculty of Medicine , ICESI University , Santiago de Cali , Colombia
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Abstract
Carotid body paraganglioma (CBP) is a type neuroendocrine tumour arising from paraganglial chief cells of carotid body. Situated at the bifurcation of the common carotid artery, it constitutes 0.5% of all body tumours. Though CBP's is most common paraganglioma of head and neck it is a rare neoplasm and requires a thorough examination for a proper diagnosis and therapeutic management. Here, we present a case of 36 year old female patient with CBP in left side of the neck.
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Affiliation(s)
| | - Jayesh S Khivasara
- Department of Head and Neck Oncology, Mahatma Gandhi Cancer Hospital, Sangli, Maharashtra, India
| | - Niharika Swain
- Department of Oral Pathology and Microbiology, MGM DCH, Navi Mumbai, Maharashtra, India
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Cano-Corres R, Sole-Enrech G, Solà-García M, Berlanga-Escalera E. Undetected paraganglioma by functional imaging techniques: case report. Clin Chem Lab Med 2018; 57:e27-e29. [DOI: 10.1515/cclm-2018-0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/20/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Ruth Cano-Corres
- Clinical Laboratory, Biochemistry Department , Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Tauli 1, CP: 08208 , Sabadell, Barcelona , Spain , Phone: +93.745.84.39
| | - Gemma Sole-Enrech
- Clinical Laboratory, Biochemistry Department , Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona , Sabadell, Barcelona , Spain
| | - Marta Solà-García
- Department of Radiology , Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona , Sabadell , Spain
| | - Eugenio Berlanga-Escalera
- Clinical Laboratory, Biochemistry Department , Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona , Sabadell, Barcelona , Spain
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