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Broso F, Gatto P, Sidarovich V, Ambrosini C, De Sanctis V, Bertorelli R, Zaccheroni E, Ricci B, Destefanis E, Longhi S, Sebastiani E, Tebaldi T, Adami V, Quattrone A. Alpha-1 Adrenergic Antagonists Sensitize Neuroblastoma to Therapeutic Differentiation. Cancer Res 2023; 83:2733-2749. [PMID: 37289021 DOI: 10.1158/0008-5472.can-22-1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/28/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
Neuroblastoma (NB) is an aggressive childhood tumor, with high-risk cases having a 5-year overall survival probability of approximately 50%. The multimodal therapeutic approach for NB includes treatment with the retinoid isotretinoin (13-cis retinoic acid; 13cRA), which is used in the post-consolidation phase as an antiproliferation and prodifferentiation agent to minimize residual disease and prevent relapse. Through small-molecule screening, we identified isorhamnetin (ISR) as a synergistic compound with 13cRA in inhibiting up to 80% of NB cell viability. The synergistic effect was accompanied by a marked increase in the expression of the adrenergic receptor α1B (ADRA1B) gene. Genetic knockout of ADRA1B or its specific blockade using α1/α1B adrenergic antagonists led to selective sensitization of MYCN-amplified NB cells to cell viability reduction and neural differentiation induced by 13cRA, thus mimicking ISR activity. Administration of doxazosin, a safe α1-antagonist used in pediatric patients, in combination with 13cRA in NB xenografted mice exerted marked control of tumor growth, whereas each drug alone was ineffective. Overall, this study identified the α1B adrenergic receptor as a pharmacologic target in NB, supporting the evaluation of adding α1-antagonists to the post-consolidation therapy of NB to more efficiently control residual disease. SIGNIFICANCE Targeting α-adrenergic receptors synergizes with isotretinoin to suppress growth and to promote differentiation of neuroblastoma, revealing a combinatorial approach for more effective management of the disease and prevention of relapse.
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Affiliation(s)
- Francesca Broso
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Pamela Gatto
- High-Throughput Screening (HTS) and Validation Core Facility, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Viktoryia Sidarovich
- High-Throughput Screening (HTS) and Validation Core Facility, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Chiara Ambrosini
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Veronica De Sanctis
- Next Generation Sequencing (NGS) Core Facility LaBSSAH, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Roberto Bertorelli
- Next Generation Sequencing (NGS) Core Facility LaBSSAH, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Elena Zaccheroni
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Benedetta Ricci
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Eliana Destefanis
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Sara Longhi
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Enrico Sebastiani
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Toma Tebaldi
- Laboratory of RNA and Disease Data Science, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
- Section of Hematology, Yale Cancer Center and Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Valentina Adami
- High-Throughput Screening (HTS) and Validation Core Facility, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Alessandro Quattrone
- Laboratory of Translational Genomics, Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
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Liu J, Zurakowski D, Weldon C, Umaretiya P, Holzman R, Lin YC. Perioperative hypertension and anesthetic management in patients undergoing resection of neuroblastoma. Paediatr Anaesth 2023. [PMID: 37052325 DOI: 10.1111/pan.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Neuroblastoma is the most common extracranial pediatric tumor, accounting for 5-8% of all childhood cancers. Neuroblastomas arise from catecholamine-secreting neural crest cells and their metabolites, vanillylmandelic acid and homovanillic acid, that are readily detected in urine. Although rarely seen in clinical practice, case reports exist documenting severe intraoperative hypertension. However, data on the incidence of intraoperative hypertension are lacking. METHODS This report is a single-center retrospective review of patients with neuroblastoma who underwent surgical resection (n = 102) at Boston Children's Hospital from July 1, 2012 to February 28, 2021. Significant intraoperative hypertension was defined as maximum systolic blood pressure greater than 95th percentile +12 mmHg based on normative blood pressure data. Statistical analysis was performed using Fisher's exact test, Wilcoxon rank-sum test, and logistic regression. RESULTS The overall incidence of intraoperative hypertension was 13% (n = 13/102). Higher American Society of Anesthesiologists (ASA) physical status was associated with intraoperative hypertension. Antihypertensive medications were administered intraoperatively in 9% of cases (n = 9), and the use was significantly associated with intraoperative hypertension. Of patients with preoperative urine catecholamine data (n = 82), all 10 patients who had intraoperative hypertension were noted to have elevated preoperative urine catecholamines. Intraoperative hypertension was not associated with postoperative hypertension, postoperative hypotension, or increased intensive care unit length of stay. DISCUSSION/CONCLUSION Intraoperative hypertension in patients with neuroblastoma remains a relatively uncommon occurrence; however, it does occur at a frequency higher than previously described. While intraoperative hypertension is associated with an increased use of antihypertensive medications in the operating room, it is not associated with adverse perioperative outcomes.
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Affiliation(s)
- Jia Liu
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Weldon
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Puja Umaretiya
- Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Holzman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuan-Chi Lin
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Harding M, Deyell RJ, Blydt-Hansen T. Catecholamines in neuroblastoma: Driver of hypertension, or solely a marker of disease? Cancer Rep (Hoboken) 2021; 5:e1569. [PMID: 34612613 PMCID: PMC9351666 DOI: 10.1002/cnr2.1569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022] Open
Abstract
Background Neuroblastoma is a common solid tumor of childhood and is often associated with hypertension. Potential etiologies contributing to hypertension include renal compression, pain, volume overload, and catecholamine secretion. Cases We completed a single center retrospective review of children with neuroblastoma and ≥stage II hypertension (per Hypertension Canada guidelines) over a 2‐year period. All patients (n = 10) had elevated urine normetanephrine levels and eight had intra‐abdominal tumors. Four patients had refractory hypertension requiring > three agents, of which three required alpha/beta blockade. Conclusion Although multifactorial, hypertension in neuroblastoma often has a neuroendocrine component. Excess normetanephrine production in neuroblastoma may be a more common hypertensive mechanism than previously appreciated. Urinary normetanephrine elevation could suggest potential neuroendocrine‐mediated hypertension.
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Affiliation(s)
- Matthew Harding
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Tom Blydt-Hansen
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Pio L, Avanzini S, Mattioli G, Martucciello G, Sementa AR, Conte M, Gigliotti A, Granata C, Leva E, Fagnani AM, Caccioppoli U, Tedesco N, Schleef J, Tirtei E, Siracusa F, D'Angelo P, Lelli Chiesa P, Miglionico L, Noccioli B, Severi E, Carlini C, Vaccarella F, Camoglio F, Cesaro S, Narciso A, Riccipetitoni G, Cecchetto G, Inserra A. Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP). J Pediatr Surg 2017; 52:1633-1636. [PMID: 28711167 DOI: 10.1016/j.jpedsurg.2017.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. METHODS A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. RESULTS From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36months (range 4-96months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. CONCLUSION Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Luca Pio
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova.
| | | | - Girolamo Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova
| | - Giuseppe Martucciello
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova
| | | | | | - Annarita Gigliotti
- Epidemiology Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genova
| | | | - Ernesto Leva
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Anna Maria Fagnani
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | | | - Nino Tedesco
- Surgical Oncology Unit, A.O.R.N. Santobono Pausilipon, Napoli
| | - Jurgen Schleef
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Torino
| | - Elisa Tirtei
- Oncology Unit, Ospedale Infantile Regina Margherita, Torino
| | | | - Paolo D'Angelo
- Oncology Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospital, Palermo
| | | | - Lucia Miglionico
- Oncology Unit, Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Bruno Noccioli
- Pediatric Surgery Unit, Ospedale Pediatrico Meyer, Firenze
| | - Elisa Severi
- Pediatric Surgery Unit, Ospedale Pediatrico Meyer, Firenze
| | - Claudio Carlini
- Pediatric Surgery Unit, ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | - Francesco Camoglio
- Pediatric Surgery Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona
| | - Simone Cesaro
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona
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Gómez-Ríos MÁ, Nuño FC, Barreto-Calvo P. Anesthetic management of an infant with giant abdominal neuroblastoma. Braz J Anesthesiol 2017; 67:210-213. [PMID: 28236871 DOI: 10.1016/j.bjane.2014.07.012] [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: 07/06/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022] Open
Abstract
Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.
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Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain.
| | - Federico Curt Nuño
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain
| | - Purísima Barreto-Calvo
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain
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6
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[Anesthetic management of an infant with giant abdominal neuroblastoma]. Rev Bras Anestesiol 2017; 67:210-213. [PMID: 28081907 DOI: 10.1016/j.bjan.2016.12.010] [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: 07/06/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022] Open
Abstract
Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.
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Abstract
Neuroblastoma is the most common extracranial solid tumor in children. Mild hypertension is a frequent symptom, presumably an effect of catecholamines that tumors release. Reported herein is the rare occurrence of severe hypertension and subsequent heart failure attributable to adrenal gland neuroblastoma. A 3-year-old boy presented with anterior chest wall protrusion. Physical examination revealed severe hypertension, and left-sided cardiac failure was evident by echocardiography. Catecholamine metabolite (norepinephrine) levels were increased in serum (>2,000 pg/mL) and in urine (1,350.5 µg/day). Abdominal computed tomography scan showed a 7 cm solid mass arising from right adrenal gland. Oral phenoxybenzamine was given for hemodynamic stabilization, and right adrenalectomy was performed to remove an apparent pheochromocytoma. Ultimately, the pathologic diagnosis was ganglioneuroblastoma. Both hypertension and cardiac failure resolved postoperatively.
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Affiliation(s)
- Suk-Bae Moon
- Department of Surgery, Kangwon National University Hospital, Kangwon National School of Medicine, Kangwon National University, Chuncheon, South Korea
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8
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Kako H, Taghon T, Veneziano G, Aldrink JH, Ayoob R, Tobias JD. Severe intraoperative hypertension after induction of anesthesia in a child with a neuroblastoma. J Anesth 2013; 27:464-7. [DOI: 10.1007/s00540-012-1544-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/09/2012] [Indexed: 11/29/2022]
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9
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Latendresse TR, Goldin AB, Jonmarker C. Anesthesia for pheochromocytoma resection in a child with Fontan circulation. Can J Anaesth 2011; 58:642. [DOI: 10.1007/s12630-011-9507-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/08/2011] [Indexed: 11/29/2022] Open
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10
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Latham GJ, Greenberg RS. Anesthetic considerations for the pediatric oncology patient--part 2: systems-based approach to anesthesia. Paediatr Anaesth 2010; 20:396-420. [PMID: 20199611 DOI: 10.1111/j.1460-9592.2010.03260.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
One of the prices paid for chemo- and radiotherapy of cancer in children is damage to the vulnerable and developing healthy tissues of the body. Such damage can exist clinically or subclinically and can become apparent during active antineoplastic treatment or during remission decades later. Furthermore, effects of the tumor itself can significantly impact the physiologic state of the child. The anesthesiologist who cares for children with cancer or for survivors of childhood cancer should understand what effects cancer and its therapy can have on various organ systems. In part two of this three-part review, we review the anesthetic issues associated with childhood cancer. Specifically, this review presents a systems-based approach to the impact from both tumor and its treatment in children, followed by a discussion of the relevant anesthetic considerations.
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Affiliation(s)
- Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E., Seattle, WA 98105, USA.
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Giant, dopamine secreting thoracoabdominal neuroblastoma in a 2-year-old: rapid preoperative blockade with labetalol. J Pediatr Hematol Oncol 2010; 32:163-6. [PMID: 20147848 DOI: 10.1097/mph.0b013e3181cf1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neuroblastomas secreting large amounts of catecholamines may require preoperative antihypertensive treatment to avoid intraoperative hypertensive crises as do pheochromocytomas. This is typically achieved with alpha-adrenergic followed if necessary by beta-adrenergic receptor blockade. Because of its predominant beta-blockade, labetalol as a combined alpha-adrenergic and beta-adrenergic receptor antagonist is relatively contraindicated as sole and first agent in pheochromocytomas releasing epinephrine and norepinephrine. We report successful monotherapy with labetalol over 24 hours in a 2-year-old child with a giant thoracoabdominal neuroblastoma and predominant dopamine secretion.
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Pappas L, Seefelder C. Anesthetic consideration for radiofrequency ablation of a suspected paraganglioma metastasis in a child. Paediatr Anaesth 2009; 19:913-4. [PMID: 19691700 DOI: 10.1111/j.1460-9592.2009.03089.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Bailey AG, Mounce G. Vasoactive mediastinal mass in an infant. J Clin Anesth 2009; 21:366-8. [PMID: 19700291 DOI: 10.1016/j.jclinane.2008.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 09/02/2008] [Accepted: 09/04/2008] [Indexed: 11/27/2022]
Abstract
The case of a 6 week-old infant who presented with an anterior mediastinal mass that extended to the left neck is reported. During surgical dissection of the mass, the patient exhibited extreme hemodynamic instability consistent with a vasoactive tumor. The patient had a neuroblastoma with its origin in the posterior mediastinum, but with its mass effect in the anterior mediastinum and neck.
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Affiliation(s)
- Ann G Bailey
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7010, USA.
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Hernandez MR, Shamberger RC, Seefelder C. Catecholamine-secreting neuroblastoma in a 4-month-old infant: perioperative management. J Clin Anesth 2009; 21:54-6. [PMID: 19232942 DOI: 10.1016/j.jclinane.2008.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/03/2008] [Accepted: 06/09/2008] [Indexed: 12/01/2022]
Abstract
Preoperative alpha- and beta-adrenergic receptor block with phenoxybenzamine and labetalol, the intraoperative course of a 4-month-old infant with neuroblastoma and elevated catecholamines causing sweating, hypertension, and tachycardia, are presented. We recommend determination of catecholamine levels and pretreatment with alpha-adrenergic and--if needed--beta-adrenergic receptor antagonists in infants with neuroblastoma and hypertension, tachycardia, or sweating.
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Affiliation(s)
- Michael R Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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15
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Havekes B, Romijn JA, Eisenhofer G, Adams K, Pacak K. Update on pediatric pheochromocytoma. Pediatr Nephrol 2009; 24:943-50. [PMID: 18566838 DOI: 10.1007/s00467-008-0888-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/05/2008] [Accepted: 05/08/2008] [Indexed: 11/24/2022]
Abstract
Pheochromocytomas are rare tumors in children arising from chromaffin cells of adrenal medullary or extra-adrenal paraganglionic tissue. The tumors are characterized by synthesis, metabolism, and secretion of catecholamines. The formerly used guidelines for pheochromocytoma have been changed by recent discoveries, implementation of new approaches, and understanding of biochemistry, genetics, imaging, pathophysiology, and nomenclature of these tumors. In children, pheochromocytomas are more frequently familial, extra-adrenal, bilateral, and multifocal than in adults. Because of a highly variable clinical presentation, pheochromocytoma is often referred to as the great mimic. Measurements of plasma or urinary fractionated metanephrines are recommended as first-line biochemical tests for diagnosis, with optimum diagnostic sensitivity to be preferred over specificity. In general, localization studies must be used secondary to clinical and biochemical evidence. Adequate preoperative treatment with alpha-blockade is mandatory, including for pheochromocytomas that do not secrete but only synthesize catecholamines. Because approximately 40% of pheochromocytomas in children have a hereditary basis, proper genetic testing should be performed, with appropriate implications for future follow-up and treatment options. The risk for development of malignant disease depends highly on the underlying mutation, which may also impact recommendations concerning screening and surgical or systemic treatment. This article reviews recent advances in biochemistry, genetics, and imaging and outlines recommendations for improved evaluation and treatment of children with benign or malignant pheochromocytomas.
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Affiliation(s)
- Bas Havekes
- Reproductive Biology and Medicine Branch, Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, NIH, Bethesda, MD, 20892-1109, USA
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Haddy TB, Mosher RB, Reaman GH. Hypertension and prehypertension in long-term survivors of childhood and adolescent cancer. Pediatr Blood Cancer 2007; 49:79-83. [PMID: 16652349 DOI: 10.1002/pbc.20886] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypertension as a late effect following childhood and adolescent cancer has received little attention. Since obesity, a known risk factor for hypertension, is increased following some childhood cancers, it seems likely that significant numbers of survivors would have hypertension. PROCEDURES The records of patients seen in the Long Term Follow Up Clinic of Children's National Medical Center were examined for a single institution, retrospective study of blood pressure in survivors of childhood and adolescent cancer. Of 103 consecutive survivors who attended the clinic from January 1 through June 30, 2004, 51 (49.5%) were female and 52 (50.5%) were male. Their mean age was 14.6 years. Systolic and diastolic blood pressures for children and adolescents under 18 years of age were evaluated for hypertension and prehypertensive according to standards for age, sex, and height. Blood pressures for adults 18 years of age and older were evaluated according to standard adult values. Children and adolescents were evaluated for obesity and overweight according to body mass index (BMI) standards for age and sex. Adults were evaluated according to standard adult values. RESULTS Twenty-nine patients (28.2%) were hypertensive or prehypertensive, and 74 (71.8%) were normal. Thirty-eight patients (36.9%) were obese or overweight, and 65 (63.1%) were non-obese. Most Wilms tumor patients, 7 of 10 (70.0%), had hypertension or prehypertension, but only 4 of 10 (40.0%) were obese or overweight. CONCLUSION Careful follow-up of their blood pressure status is warranted for long-term survivors of childhood and adolescent cancer, especially for those with an initial diagnosis of Wilms tumor.
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Affiliation(s)
- Theresa B Haddy
- Department of Pediatric Hematology-Oncology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, District of Columbia 20010-2970, USA.
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Ehsani MA, Abouzari M, Rashidi A, Kohan L. Unique role of enalapril in the treatment of severe hypertension in a child with an unusual form of neuroblastoma. J Pediatr Hematol Oncol 2005; 27:569-70. [PMID: 16217265 DOI: 10.1097/01.mph.0000184633.49396.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tobias JD. Preoperative blood pressure management of children with catecholamine-secreting tumors: time for a change. Paediatr Anaesth 2005; 15:537-40. [PMID: 15960635 DOI: 10.1111/j.1460-9592.2005.01649.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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