Feocromocitoma-paraganglioma: del diagnóstico bioquímico al genético

Detection and Surgical Approach to Pheochromocytoma: A Case Report

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.

Sarcoid‑like granulomatous inflammation in a carotid body paraganglioma: A case report and mini‑review of the literature

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.

Pheochromocytoma manifesting as cortical blindness secondary to PRES with associated TMA: a case report and literature review

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.

Transperitoneal laparoscopic adrenalectomy for the resection of large size pheochromocytoma: Case report and literature review

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.

Pheochromocytoma

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.

Paraganglioma in pregnancy: interdisciplinary management during pregnancy

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.

Carotid Body Paraganglioma

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.