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Amri M, Tamir EM, Drighil A, Habbal R. Cafe-au-lait spots with resistant hypertension are an indicator of pheochromocytoma: a rare case report. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e351. [PMID: 39015197 PMCID: PMC11247971 DOI: 10.47487/apcyccv.v5i2.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/25/2024] [Indexed: 07/18/2024]
Abstract
This case report is one of the rare cases of bilateral pheochromocytoma associated with neurofibromatosis type 1. The interest lies in the clinical form in which the diagnosis was revealed. We report the case of a 38-year-old woman admitted for severe hypertension resistant to triple therapy. Clinical examination revealed Cafe-au-lait spots, which are pigmented birthmarks that appear as patches on the skin with a light to dark brown colour. More than six spots are present in an estimated 95% of people diagnosed with neurofibromatosis type 1 (NF1). Abdominal computed tomography (CT) showed bilateral adrenal tumor involvement. The diagnosis of pheochromocytoma was made by measuring urinary Vanillylmandelic acid (VMA). The evolution was favorable after the excision of the tumor, with normalization of blood pressure. In conclusion: resistant hypertension with café au lait spots may indicate pheochromocytoma, especially bilateral, suggesting an underlying genetic condition like NF1, warranting systematic screening.
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Affiliation(s)
- Meriam Amri
- Cardiology Department, Centre Hospitalo-Universitaire Ibn Rochd of Casablanca, Morocco.Cardiology DepartmentCentre Hospitalo-Universitaire Ibn Rochd of CasablancaMorocco
| | - El Mehdi Tamir
- Cardiology Department, Centre Hospitalo-Universitaire Ibn Rochd of Casablanca, Morocco.Cardiology DepartmentCentre Hospitalo-Universitaire Ibn Rochd of CasablancaMorocco
| | - Abdenasser Drighil
- Cardiology Department, Centre Hospitalo-Universitaire Ibn Rochd of Casablanca, Morocco.Cardiology DepartmentCentre Hospitalo-Universitaire Ibn Rochd of CasablancaMorocco
| | - Rachida Habbal
- Cardiology Department, Centre Hospitalo-Universitaire Ibn Rochd of Casablanca, Morocco.Cardiology DepartmentCentre Hospitalo-Universitaire Ibn Rochd of CasablancaMorocco
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Jandou I, Moataz A, Dakir M, Debbagh A, Aboutaieb R. Malignant pheochromocytoma: A diagnostic and therapeutic dilemma. Int J Surg Case Rep 2021; 83:106009. [PMID: 34052712 PMCID: PMC8175409 DOI: 10.1016/j.ijscr.2021.106009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue. The diagnosis of malignancy is based on neoplastic recurrence or the presence of metastasis in organs that lack chromaffin tissue. We report a series of four cases because of their diagnostic and therapeutic particularities. Presentation of case we describe four clinical cases of patients with malignant pheochromocytoma whose Menard triad “headache-palpitations-sweating” was present in three out of four patients, the methoxylated derivatives were measured in 4 patients, 3 of which had high values, all of our patients carried out a CT scan which objectified signs of malignancy, MRI was performed on a single patient; presenting with a neoplastic recurrence; looking for a locoregional invasion. Discussion Pheochromocytoma (PC) is a rare neuroendocrine tumor derived from the chromaffin cells of the adrenal medulla. Its annual incidence is 2 to 8 per million adults. A peak frequency is observed between 30 and 40 years of age. Approximately 10% of pheochromocytomas are malignant and in 10% of cases, bilateral localization is observed. Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy. Surgery for MAP is not always curative. In the case of multiple liver metastases, treatment is based on adrenalectomy, which can be effectively combined with chemoembolization, cryoablation, or radiofrequency techniques. Conclusion The main prognostic factors of the malignant pheochromocytomas are a large tumor volume, the existence or number of visceral metastases, and the presence of a mutation in the SDHB (Succinate dehydrogenase B) gene. Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue. A very large part of pheochromocytomas are of genetic origin which can be part of hereditary syndromes. Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy. Adequate management of this pathology requires a multidisciplinary consultation meeting
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Affiliation(s)
- Issam Jandou
- Ibn Rochd University Hospital Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Morocco.
| | - Amine Moataz
- Ibn Rochd University Hospital Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Morocco
| | - Mohammed Dakir
- Ibn Rochd University Hospital Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Morocco
| | - Adil Debbagh
- Ibn Rochd University Hospital Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Morocco
| | - Rachid Aboutaieb
- Ibn Rochd University Hospital Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Morocco
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El Bouazzaoui A, Hammas N, Houari N, Boukatta B, Oussaden A, Sbai H, Kanjaa N. [Acute coronary syndrome: a mode of uncommon revelation of pheochromocytoma]. Pan Afr Med J 2015; 22:151. [PMID: 26889332 PMCID: PMC4742046 DOI: 10.11604/pamj.2015.22.151.7505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022] Open
Abstract
Le phéochromocytome est une tumeur rare. Il se manifeste habituellement par la triade de Ménard ou par une hypertension artérielle. Des cas rares de phéochromocytome ont été révélés par un syndrome coronaire aigu. Patiente âgée de 57 ans, ayant l'antécédent d'hypertension artérielle sous amlodipine, est admise pour syndrome coronaire aigue sans sus décalage du segment ST à troponine positive. La coronarographie est revenue en faveur d'un réseau coronaire grêle sans sténose significative. Une masse tissulaire surrénalienne droite a été retrouvée sur une échographie rénale de routine et confirmée par un scanner scanner abdominal. Le dosage des cathecholamines urinaires trouve des taux très élevés d'adrénaline et de noradrenaline. Apres une préparation par un β bloquants associé à un inhibiteur calcique, l'exérèse chirurgicale de la tumeur a été réalisée par voie cœlioscopique sous monitorage hémodynamique invasif. L'examen anatomopathologique de la pièce opératoire confirme le diagnostic de phéochromocytome. L’évolution à court et moyen terme est favorable, notamment disparition de la triade de Menard, des douleurs thoraciques. La révélation d'un phéochromocytome par la survenue d'un syndrome coronaire aigu est rare, souvent ignorées, mais dont les conséquences peuvent être dramatiques. La tumorectomie peut conduire à la guérison complète et définitive des manifestations cardiaques.
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Affiliation(s)
- Abderrahim El Bouazzaoui
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Nawal Hammas
- Service d'Anatomie Pathologique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Nawfal Houari
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Brahim Boukatta
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Abdelmalek Oussaden
- Service de Chirurgie Viscérale C3, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Hicham Sbai
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
| | - Nabil Kanjaa
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Faculté de Médecine et de Pharmacie, Université Sidi Mohammed Benabdellah (USMBA), Fès, Maroc
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Eya C, Lamia BH, Samira A, Zouleikha K, Imen B, Chekib K, Narjess K. [Bilateral suprarenal pheochromocytoma: case report]. Pan Afr Med J 2013; 15:101. [PMID: 24244787 PMCID: PMC3828065 DOI: 10.11604/pamj.2013.15.101.1931] [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: 08/03/2012] [Accepted: 03/17/2013] [Indexed: 11/11/2022] Open
Abstract
Les phéochromocytomes de localisation bilatérale sont rares. Ils s'intègrent le plus souvent dans le cadre d'une maladie familiale. Néanmoins des formes bilatérales sporadiques peuvent être observées. Ainsi, chez tout patient présentant des masses surrénaliennes bilatérales, un phéochromocytome bilatéral doit être suspecté et son caractère familial ou sporadique doit être déterminé devant le risque de récidive tumorale. A ce propos, nous rapportons l'observation d'une patiente âgée de 22 ans qui a été hospitalisée pour exploration d'une hypertension artérielle de découverte récente. L'association à des céphalées, sueurs et palpitations a orienté vers le diagnostic de phéochromocytome. Les taux urinaires des dérivés méthoxylés étaient très élevés. L’échographie et l'IRM abdominales ont noté la présence de deux masses surrénaliennes bilatérales. La scintigraphie au MIBG a montré une hyperfixation au niveau des deux surrénales, sans autres localisations. L'enquête à la recherche d'une néoplasie endocrinienne multiple ou d'une phacomatose était négative. Le traitement a consisté en une surrénalectomie bilatérale par voie cœlioscopique. L’évolution sous traitement substitutif par hydrocortisone était favorable avec une normalisation des chiffres tensionnels.
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Affiliation(s)
- Cherif Eya
- Service de médecine interne B, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunisie
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5
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El Haddad S, Benchekroun N, Rhafour A, Ahbeddou S, Rhafour I, Imdary I, Idrissi Alami S, Soufi G, Berraho A. [Bilateral stellate neuroretinitis as presenting sign of pheochromocytoma]. J Fr Ophtalmol 2013; 36:600-3. [PMID: 23790444 DOI: 10.1016/j.jfo.2012.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/04/2012] [Accepted: 12/12/2012] [Indexed: 10/26/2022]
Abstract
We report the case of a 21-year-old male patient admitted emergently with progressive bilateral severe visual loss for 1 month. Posterior segment examination revealed bilateral stellate neuroretinitis. Infectious serologies were negative, and brain CT was normal. Physical examination was remarkable for malignant hypertension of 220/150 mmHg. Diagnostic work-up revealed a pheochromocytoma documented by histopathological exam upon adrenalectomy. The disc edema and macular exudates resolved once the hypertension was controlled.
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Affiliation(s)
- S El Haddad
- Service d'ophtalmologie B, CHU Ibn sina, rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc.
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Plu I, Sec I, Barrès D, Lecomte D. Pregnancy, Cesarean, and Pheochromocytoma: A Case Report and Literature Review. J Forensic Sci 2013; 58:1075-9. [DOI: 10.1111/1556-4029.12107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 04/05/2012] [Accepted: 04/14/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Isabelle Plu
- Institut medico-légal; 2 place Mazas; 75012; Paris; France
| | - Isabelle Sec
- Institut medico-légal; 2 place Mazas; 75012; Paris; France
| | - Denis Barrès
- Institut medico-légal; 2 place Mazas; 75012; Paris; France
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7
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Rousson D, Rimmelé T, Ber CE, Allaouchiche B, Bouvet L. [Incidental finding of phaeochromocytoma during surgery: the anaesthesiologist's nightmare]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:172-5. [PMID: 22285940 DOI: 10.1016/j.annfar.2011.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022]
Abstract
We report the case of a patient who presented hypertension paroxysmal with acute pulmonary oedema followed by cardiocirculatory arrest during gynaecological surgery for resection of latero-aortic lymph nodes suspected to be cervical cancer metastases. This intervention, originally oncologic, has discovered ectopic phaeochromocytoma a posteriori. The management of perioperative serious adverse events revealing the undiagnosed phaeochromocytoma is discussed.
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Affiliation(s)
- D Rousson
- Service d'anesthésie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
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8
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Martiniova L, Perera SM, Brouwers FM, Alesci S, Abu-Asab M, Marvelle AF, Kiesewetter DO, Thomasson D, Morris JC, Kvetnansky R, Tischler AS, Reynolds JC, Fojo AT, Pacak K. Increased uptake of [¹²³I]meta-iodobenzylguanidine, [¹⁸F]fluorodopamine, and [³H]norepinephrine in mouse pheochromocytoma cells and tumors after treatment with the histone deacetylase inhibitors. Endocr Relat Cancer 2011; 18:143-57. [PMID: 21098082 PMCID: PMC4110720 DOI: 10.1677/erc-10-0090] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
[¹³¹I]meta-iodobenzylguanidine ([¹³¹I]MIBG) is the most commonly used treatment for metastatic pheochromocytoma and paraganglioma. It enters the chromaffin cells via the membrane norepinephrine transporter; however, its success has been modest. We studied the ability of histone deacetylase (HDAC) inhibitors to enhance [¹²³I]MIBG uptake by tumors in a mouse metastatic pheochromocytoma model. HDAC inhibitors are known to arrest growth, induce differentiation and apoptosis in various cancer cells, and further inhibit tumor growth. We report the in vitro and in vivo effects of two HDAC inhibitors, romidepsin and trichostatin A, on the uptake of [(3)H]norepinephrine, [¹²³I]MIBG, and [(18)F]fluorodopamine in a mouse model of metastatic pheochromocytoma. The effects of both inhibitors on norepinephrine transporter activity were assessed in mouse pheochromocytoma (MPC) cells by using the transporter-blocking agent desipramine and the vesicular-blocking agent reserpine. HDAC inhibitors increased [(3)H]norepinephrine, [¹²³I]MIBG, and [(18)F]fluorodopamine uptake through the norepinephrine transporter in MPC cells. In vivo, inhibitor treatment resulted in significantly increased uptake of [(18)F]fluorodopamine positron emission tomography (PET) in pheochromocytoma liver metastases (19.1 ± 3.2% injected dose per gram of tumor (%ID/g) compared to liver metastases in pretreatment scans 5.9 ± 0.6%; P<0.001). Biodistribution analysis after inhibitors treatment confirmed the PET results. The uptake of [(123)I]MIBG was significantly increased in liver metastases 9.5 ± 1.1% compared to 3.19 ± 0.4% in untreated control liver metastases (P<0.05). We found that HDAC inhibitors caused an increase in the amount of norepinephrine transporter expressed in tumors. HDAC inhibitors may enhance the therapeutic efficacy of [(131)I]MIBG treatment in patients with advanced malignant pheochromocytoma and paraganglioma.
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Affiliation(s)
- Lucia Martiniova
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Shiromi M. Perera
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Frederieke M. Brouwers
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Salvatore Alesci
- Clinical Neuroendocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Mones Abu-Asab
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Amanda F. Marvelle
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Dale O. Kiesewetter
- Intramural Science PRGMS, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - David Thomasson
- Laboratory of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, Bethesda, MD, 20892 USA
| | - John C. Morris
- Metabolism Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Richard Kvetnansky
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Arthur S. Tischler
- Department of Pathology, Tufts University School of Medicine and Tufts Medical Center, Boston, MA, 02111, USA
| | - James C Reynolds
- Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - A. Tito Fojo
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
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Manifestations cardiaques des phéochromocytomes. ANNALES D'ENDOCRINOLOGIE 2009; 70:43-7. [DOI: 10.1016/j.ando.2008.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 11/18/2008] [Indexed: 11/22/2022]
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10
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Phéochromocytome intracardiaque. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Cheikhrouhou H, Khiari K, Chérif L, Hadj Ali I, Héni M, Rajhi H, Ben Abdallah N. Les phéochromocytomes malins : à propos de trois observations. ANNALES D'ENDOCRINOLOGIE 2006; 67:238-44. [PMID: 16840915 DOI: 10.1016/s0003-4266(06)72592-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The authors report three cases of malignant pheochromocytomas. Metastases occurred in the liver in two cases whereas malignancy was suspected in the third case because of recurrence and local invasion. One case was pregnant at diagnosis of pheochromocytoma. Pheochromocytoma was associated to papillary thyroïd carcinoma in another case. The treatment considered was surgery in all cases.
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Affiliation(s)
- H Cheikhrouhou
- Service de Médecine interne A et d'Endocrinologie, hôpital Charles Nicolle, boulevard du 9 Avril, 1006 BS, Tunis, Tunisie
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12
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Guillemot J, Anouar Y, Montero-Hadjadje M, Grouzmann E, Grumolato L, Roshmaninho-Salgado J, Turquier V, Duparc C, Lefebvre H, Plouin PF, Klein M, Muresan M, Chow BKC, Vaudry H, Yon L. Circulating EM66 is a highly sensitive marker for the diagnosis and follow-up of pheochromocytoma. Int J Cancer 2006; 118:2003-12. [PMID: 16287097 DOI: 10.1002/ijc.21571] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have previously demonstrated that measurement of tissue concentration of the novel secretogranin II-derived peptide EM66 may help to discriminate between benign and malignant pheochromocytomas. The aim of the present study was to characterize EM66 in plasma and urine of healthy volunteers and pheochromocytoma patients, in order to further evaluate the usefulness of this peptide as a circulating marker for the management of the tumors. HPLC analysis of plasma and urine samples demonstrated that the EM66-immunoreactive material coeluted with the recombinant peptide. In healthy volunteers, plasma and urinary EM66 levels were, respectively, 2.6 (1.9-3.7) ng/ml and 2.9 (1.9-4.6) ng/ml. In patients with pheochromocytoma, plasma EM66 levels were 10-fold higher than those of healthy volunteers (26.9 (7.3-44) ng/ml), and returned to normal values after removal of the tumor. In contrast, urinary EM66 levels were not significantly different from those of healthy volunteers (3.2 (2.2-3.9) ng/ml). Measurement of total or free plasma metanephrines and 24 hr urinary metanephrines in our series of patients revealed that these tests, taken separately, are less sensitive than the EM66 determination. Pheochromocytes in primary culture secreted high levels of EM66, suggesting that the chromaffin tumor was actually responsible for the increased plasma peptide concentrations in the patients. These data indicate that EM66 is secreted in the general circulation and that elevated plasma EM66 levels are correlated with the occurrence of pheochromocytoma. Thus, EM66 is a sensitive plasma marker that should be considered as a complementary tool in the management of pheochromocytoma.
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Affiliation(s)
- Johann Guillemot
- INSERM U413, Laboratory of Cellular and Molecular Neuroendocrinology, European Institute for Peptide Research (IFRMP 23), University of Rouen, Mont-Saint-Aignan, France
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13
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Oger P, Raiffort C, Plouin PF, Mandelbrot L. Phéochromocytome et grossesse. À propos d'un cas. ACTA ACUST UNITED AC 2006; 34:323-5. [PMID: 16564734 DOI: 10.1016/j.gyobfe.2005.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 12/02/2005] [Indexed: 11/16/2022]
Abstract
The management of a pheochromocytoma during pregnancy is uncommon and is at high risk for both mother and foetus. We report a case of a patient whose first pregnancy was complicated by foetal demise in a context suggestive of preeclampsia. She was diagnosed with pheochromocytoma as she was beginning a second pregnancy. A laparoscopic adrenalectomy was performed in the first trimester of pregnancy, and maternal and neonatal outcome were favourable. This case illustrates the difficulty of diagnosing pheochromocytoma in pregnancy, and the benefits of laparoscopic treatment in the first trimester.
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Affiliation(s)
- P Oger
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
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14
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Ouchikhe A, Lehoux P, Gringore A, Renouf P, Deredec R, Tasle M, Massetti M, Khayat A, Saloux E, Grollier G, Samama G, Gérard JL. Le phéochromocytome comme cause inhabituelle de choc cardiogénique. ACTA ACUST UNITED AC 2006; 25:46-9. [PMID: 16386403 DOI: 10.1016/j.annfar.2005.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 08/29/2005] [Indexed: 11/19/2022]
Abstract
The authors reported a case involving a young patient with a cardiogenic shock associated to an acute pulmonary oedema. According to the seriousness of the shock, an external ventricular assist device (VAD) was initially inserted and replaced thereafter because of the cardiovascular instability, by an external pneumatic biventricular assist device. A cardiogenic shock induced by an acute adrenergic myocarditis due to a phaeochromocytoma was diagnosed. The patient was weaned from the VAD on day 84 and was scheduled for elective surgery of the phaeochromocytoma on day 93. The authors discussed the time of the surgery according to the anticoagulation therapy necessary to the VAD and the necessary caution taken if a cardiogenic shock appeared around surgery.
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Affiliation(s)
- A Ouchikhe
- Département d'anesthésie-réanimation et de médecine d'urgence, CHU Côte-de-Nacre, 14033 Caen, France.
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15
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Henry A, Charpiat B, Vial T, Franchini S, Cuilleret FJ, Milon H. Pheochromocytoma unmasked by amisulpride and tiapride. Ann Pharmacother 2005; 39:970-2. [PMID: 15811908 DOI: 10.1345/aph.1e510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the unmasking of pheochromocytoma in a patient treated with amisulpride and tiapride. CASE SUMMARY A 42-year-old white man developed acute hypertension with severe headache and vomiting 2 hours after the first doses of amisulpride 100 mg and tiapride 100 mg. Both drugs were immediately discontinued, and the patient recovered after subsequent nicardipine and verapamil treatment. Abdominal ultrasound showed an adrenal mass, and postoperative histologic examination confirmed the diagnosis of pheochromocytoma. DISCUSSION Drug-induced symptoms of pheochromocytoma are often associated with the use of substituted benzamide drugs, but the underlying mechanism is unknown. In our case, use of the Naranjo probability scale indicated a possible relationship between the hypertensive crisis and amisulpride and tiapride therapy. CONCLUSIONS As of March 24, 2005, this is the first reported case of amisulpride- and tiapride-induced hypertensive crisis in a patient with pheochromocytoma. Physicians and other healthcare professionals should be aware of this potential adverse effect of tiapride and amisulpride.
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Affiliation(s)
- Agnès Henry
- Pharmacy Department, Croix-Rousse Hospital, Lyon, France.
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Sawka AM, Prebtani APH, Thabane L, Gafni A, Levine M, Young WF. A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma. BMC Endocr Disord 2004; 4:2. [PMID: 15225350 PMCID: PMC459231 DOI: 10.1186/1472-6823-4-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 06/29/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. METHODS: We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. RESULTS: Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%-100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%-100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07). CONCLUSION: Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.
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Affiliation(s)
- Anna M Sawka
- Department of Internal Medicine, St. Joseph's Healthcare, Hamilton, Ontario, L8N 4A6, Canada
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
- Hoffmann-La Roche Research Fellow in Health Economics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
| | - Ally PH Prebtani
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
- Department of Internal Medicine, Hamilton General Hospital, Hamilton, Ontario, L8L 2X2, Canada
| | - Lehana Thabane
- Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Ontario, L8N 1G6, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
| | - Mitchell Levine
- Department of Internal Medicine, St. Joseph's Healthcare, Hamilton, Ontario, L8N 4A6, Canada
- Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Ontario, L8N 1G6, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
| | - William F Young
- Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
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Giovanella L, Ceriani L. Serum Chromogranin-A Immunoradiometric Assay in the Diagnosis of Pheochromocytoma. Int J Biol Markers 2002; 17:130-4. [PMID: 12113580 DOI: 10.1177/172460080201700209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BackgroundThe diagnosis of pheochromocytoma is based on laboratory tests that demonstrate an increase in urinary excretion of catecholamines or their metabolites. Chromogranin A (CgA) is a member of the granin family and is widely distributed in neuroendocrine cells and particularly in chromaffin adrenal cells. Consequently, serum CgA increases in patients affected by pheochromocytoma and other diseases of the chromaffin system.AimThis study investigated the performance of serum CgA assay in the diagnosis of pheochromocytoma and compared serum CgA with 24-hour urinary epinephrine (E), norepinephrine (NE), vanillylmandelic acid (VMA) and metanephrines (MNs).MethodsWe enrolled 15 patients with histologically proven pheochromocytoma; 100 healthy blood donors and 148 patients with essential hypertension were enrolled as controls. Serum CgA was assayed by a specific immunoradiometric method (IRMA). Urinary tests were done with high performance liquid chromatography (HPLC).ResultsCirculating CgA showed a higher sensitivity (1.00), specificity (0.96) and accuracy (0.96) than all other tests. Serum levels of CgA clearly increased from blood donors and patients with essential hypertension to patients with pheochromocytoma (p<0.0001). Furthermore, a strong relationship between serum CgA and tumor mass was found (p<0.0001). In conclusion, our data suggest that the CgA assay might be used as a single test for the diagnosis of pheochromocytoma.
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Affiliation(s)
- L Giovanella
- Department of Nuclear Medicine, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
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