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DAMASKOS C, GARMPIS N, DIMITROULIS D, GARMPI A, FARMAKI P, PATSOURAS A, GEORGAKOPOULOU VE, KYRIAKOS G, QUILES-SANCHEZ LV, SYLLAIOS A, LIAKEA A, DIAMANTIS E. Concomitant Existence of Bilateral Adrenal Adenomas. To Operate or Not? MAEDICA 2021; 16:723-728. [PMID: 35261678 PMCID: PMC8897775 DOI: 10.26574/maedica.2020.16.4.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nowadays, through the wide use of both magnetic resonance imaging and computed tomography, the diagnosis of adrenal incidentaloma is becoming increasingly frequent. Pheochromocytomas are neuroendocrine tumors which produce catecholamine, and they are characterized by headaches, palpitations, sweating and hypertension. Aldosterone-secreting adrenal cortical adenomas can cause various metabolic and cardiovascular diseases due to aldosterone excess. Our aim is to present a rare case of a concomitant existence of pheochromocytoma in the right adrenal and a functioning adrenal cortical adenoma in the left, worthwhile mentioning since the appearance of these two entities in different location in the same patient is unprecedented. The treatment remains challenging.
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Affiliation(s)
- Christos DAMASKOS
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos GARMPIS
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios DIMITROULIS
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna GARMPI
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi FARMAKI
- First Department of Pediatrics, Agia Sofia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Georgios KYRIAKOS
- Seccion de Endocrinologia y Nutrition, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | | | - Athanasios SYLLAIOS
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki LIAKEA
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos DIAMANTIS
- Academic Department of Internal Medicine, Endocrinology Unit, General Oncology Hospital of Kifisia Agioi Anargyroi, National and Kapodistrian University of Athens, Athens, Greece
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Susheela AT, Eldib H, Vinnakota D, Bial A, Ali S, Koh H, Lavery B, Gorbien M. Recurrent Pheochromocytoma in an Elderly Patient. ACTA ACUST UNITED AC 2020; 56:medicina56060316. [PMID: 32604789 PMCID: PMC7353891 DOI: 10.3390/medicina56060316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
Pheochromocytomas are rare neuroendocrine tumors that can affect people of all ages and are commonly diagnosed in the 4th and 5th decades of life. Familial pheochromocytomas are diagnosed mostly between the 2nd and 3rd decades of life. They can be benign or metastatic and often present as isolated tumors or along with other neuroendocrine syndromes. We present a case of an elderly man who underwent laparoscopic adrenalectomy for pheochromocytoma at the age of 60 years but developed recurrence of metastatic pheochromocytoma after ten years. We also conducted a literature review to understand the epidemiology and presentation of the tumor and to emphasize that there should be a low threshold of suspicion for timely diagnosis and management of recurrent pheochromocytoma.
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Labib M, Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Adrenalectomy for huge solid pheochromocytoma: a challenging surgery or piece of cake? J Surg Case Rep 2019; 2019:rjz255. [PMID: 31462986 PMCID: PMC6705450 DOI: 10.1093/jscr/rjz255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022] Open
Abstract
Pheochromocytoma (PCC) is an uncommon adrenal tumor that is occasionally diagnosed during the work up for patients with uncontrolled hypertension. Treatment of PCC is mainly surgical. This case represents the largest PCC reported to date, which was safely removed.
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Affiliation(s)
- Mahmoud Labib
- Anesthesia Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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The Highs and Lows of an Unknown Pheochromocytoma in an Elderly Patient. Case Rep Endocrinol 2019; 2019:5707968. [PMID: 31360556 PMCID: PMC6642778 DOI: 10.1155/2019/5707968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
Pheochromocytomas are rare catecholamine producing neuroendocrine tumors. The incidence of these tumors is estimated to affect 0.8 per 100,000 person-years and is most common in the fourth to fifth decade of life with equal prevalence in men and women. We describe a case of an 84-year-old male who presented with cycling episodes of severe hypertension and hypotension after an elective cardiac catheterization. Workup of the labile blood pressure revealed a large suprarenal mass and free serum metanephrines (MN) 104 nmol/L (reference range 0.0-0.49 nmol/L) and normetanephrines (NMN) of 24 nmol/L (reference range 0.0-0.89 nmol/L), confirming the diagnosis of a pheochromocytoma. The patient's labile blood pressure was a challenge to manage medically and improved only after aggressive hydration and an alpha-adrenergic antagonist. Of note, this is the second eldest patient known to be published to date with a pheochromocytoma.
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Samejima M, Taguchi S, Miyagawa S, Matsumoto R, Omura S, Ninomiya N, Nakamura Y, Yamaguchi T, Kinjo M, Tambo M, Okegawa T, Koba T, Matsuki R, Jimbo I, Motoyasu A, Tsumura T, Shimoyamada H, Shibahara J, Sakamoto Y, Fukuhara H. Acute hypotension induced by suction of cystic fluid containing extremely high concentrations of catecholamines during resection of giant pheochromocytoma. IJU Case Rep 2019; 2:218-220. [PMID: 32743418 PMCID: PMC7292151 DOI: 10.1002/iju5.12087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Since pheochromocytomas present with various complications due to catecholamine hypersecretion, their perioperative management needs special attention. Case presentation A 45‐year‐old man visited our hospital with a complaint of abdominal swelling. Radiological and endocrinological assessments determined the tumor as a giant (>20 cm) cystic pheochromocytoma. After administration of doxazosin, the patient underwent radical surgery. Since the tumor was extremely large and fixed to surrounding structures, we punctured it and aspirated cystic fluid to improve the tumor's mobility. However, during the aspiration, the patient developed acute hypotension, which could be reversed by suction withdrawal and vasopressor administration. A similar event occurred during a second aspiration. Eventually, the tumor was successfully excised with negative surgical margin. The cystic fluid proved to contain extremely high concentrations of catecholamines, which might result in the hypotension. Conclusion We report the first case who developed acute hypotension due to aspiration of cystic fluid from giant pheochromocytoma.
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Affiliation(s)
- Mio Samejima
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Satoru Taguchi
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Shogo Miyagawa
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Ryuki Matsumoto
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Shota Omura
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Naoki Ninomiya
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Yu Nakamura
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Tsuyoshi Yamaguchi
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Manami Kinjo
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Mitsuhiro Tambo
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Takatsugu Okegawa
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Tsuyuha Koba
- Department of Surgery Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Ryota Matsuki
- Department of Surgery Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Ippei Jimbo
- Department of Anesthesiology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Akira Motoyasu
- Department of Anesthesiology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Tetsuro Tsumura
- Third Department of Internal Medicine Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Hiroaki Shimoyamada
- Department of Pathology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Junji Shibahara
- Department of Pathology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Yoshihiro Sakamoto
- Department of Surgery Kyorin University Faculty of Medicine Mitaka Tokyo Japan
| | - Hiroshi Fukuhara
- Department of Urology Kyorin University Faculty of Medicine Mitaka Tokyo Japan
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