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Loukili MA, Assarrar I, El Yamani N, Haloui A, Rouf S, Latrech H. Functional retroperitoneal paraganglioma invading the inferior vena cava in the elderly, a case report and literature review. Int J Surg Case Rep 2023; 109:108547. [PMID: 37517253 PMCID: PMC10400874 DOI: 10.1016/j.ijscr.2023.108547] [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: 06/01/2023] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Phaeochromocytomas and paragangliomas are rare neuroendocrine neoplasms that grow outside the adrenal gland and arise from the primitive neural crest cells. The retroperitoneal location is extremely rare with an incidence of 2-8 per million. CASE PRESENTATION Here we report a case of an 80 years old man presenting with abdominal pain and vomiting associated with hypertensive peaks and weight loss. CT scan showed a retroperitoneal para-aortic tumor invading the inferior vena cava, with significantly elevated urinary catecholamine levels. Histopathological and immunohistochemistry examinations confirmed the diagnosis of paraganglioma. A medical preparation by alpha-blockers was performed. Complete resection of the tumor with the reconstruction of the vena cava was achieved without postoperative complications. After surgery, blood pressure and HbA1c were on the targets and the urinary catecholamine levels were normal. CLINICAL DISCUSSION The diagnosis of paragangliomas is suspected by clinical symptoms in the case of functional paragangliomas and the confirmation is biological by the plasmatic or urinary catecholamines. Non-functional paragangliomas often represent a diagnostic challenge. In our case, the large size, the location of the tumor, and the invasion of adjacent structures represented a surgical challenge to perform a complete resection. CONCLUSION In the elderly, this pathology is quite uncommon. Retroperitoneal paraganglioma is a rare location of this type of tumor. Endocrinologists, surgeons, and anesthesiologists should work together to ensure an appropriate diagnosis and treatment of paraganglioma. The gold standard treatment is the complete resection after a medical preparation.
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Affiliation(s)
- Mohamed Aymane Loukili
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco
| | - Imane Assarrar
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco
| | - Nada El Yamani
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco
| | - Anass Haloui
- Department of Anatomical Pathology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco
| | - Siham Rouf
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University of Mohammed first, Oujda, Morocco
| | - Hanane Latrech
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy, University of Mohammed 1st, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University of Mohammed first, Oujda, Morocco.
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Wang J, Liu Q, Jiang S, Zhang J, He J, Li Y, Wang D. Preoperative α-blockade versus no blockade for pheochromocytoma-paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis. Int J Surg 2023; 109:1470-1480. [PMID: 37037514 PMCID: PMC10389437 DOI: 10.1097/js9.0000000000000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Surgical resection of pheochromocytomas and paragangliomas (PPGLs) is associated with a significant risk of intraoperative hemodynamic instability and cardiovascular complications. α-blockade remains the routine preoperative medical preparation despite controversies over the lack of evidence. We presented an updated meta-analysis to ulteriorly evaluate the potential efficacy of preoperative α-blockade versus no blockade for PPGL patients undergoing surgery. MATERIALS AND METHODS Randomized and nonrandomized comparative studies assessing preoperative α-blockade for PPGL surgery in adults were identified through a systematic literature search via MEDLINE, Embase, Web of Science, and CENTRAL up to November 2022. Outcome data of intraoperative hemodynamic parameters and major postoperative events were extracted. Mean difference and risk ratio were synthesized as appropriate for each outcome to determine the cumulative effect size. RESULTS Fifteen nonrandomized studies involving 3542 patients were finally eligible. Intraoperatively, none of the analyzed hemodynamic parameters differed between patients with or without α-blockade: maximum and minimum systolic blood pressure, hypertensive and hypotensive hemodynamic instability episodes, and peak heart rate, subgroup analysis of normotensive PPGL patients yielded similar results with the overall effects. Postoperatively, α-blockade was associated with prolonged hypotension and vasopressor usage (risk ratio: 4.21, 95% CI: 1.17-15.18, P =0.03). ICU admission, length of stay, overall cardiovascular morbidity, and mortality were similar between the two groups. CONCLUSIONS Preoperative α-blockade ensured neither more stable intraoperative hemodynamics nor better perioperative outcome over no blockade for PPGL surgery. However, large-volume randomized controlled trials are still warranted to ascertain these findings.
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Affiliation(s)
- Jue Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
- Department of Urology, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China
| | - Qingyuan Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Shihao Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jindong Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jinke He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yunfan Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Delin Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
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3
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Advances in Endocrine Surgery. Surg Oncol Clin N Am 2023; 32:199-220. [PMID: 36410918 DOI: 10.1016/j.soc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent changes in the landscape of endocrine surgery include a shift from total thyroidectomy for almost all patients with papillary thyroid cancer to the incorporation of thyroid lobectomy for well-selected patients with low-risk disease; minimally invasive parathyroidectomy with, and potentially without, intraoperative parathyroid hormone monitoring for patients with well-localized primary hyperparathyroidism; improvement in the management of parathyroid cancer with the incorporation of immune checkpoint blockade and/or targeted therapies; and the incorporation of minimally invasive techniques in the management of patients with benign tumors and selected secondary malignancies of the adrenal gland.
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Yang Y, Zhang J, Fang L, Jia X, Zhang W. Non-Selective Alpha-Blockers Provide More Stable Intraoperative Hemodynamic Control Compared with Selective Alpha1-Blockers in Patients with Pheochromocytoma and Paraganglioma: A Single-Center Retrospective Cohort Study with a Propensity Score-Matched Analysis from China. Drug Des Devel Ther 2022; 16:3599-3608. [PMID: 36262769 PMCID: PMC9574264 DOI: 10.2147/dddt.s378796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Alpha-adrenergic blockers are used in the preoperative preparation of patients with pheochromocytomas and paragangliomas (PPGLs) despite the controversial on perioperative hemodynamics. We aimed to determine whether selective or non-selective α-adrenergic blockers can provide better efficacy on patients' intraoperative hemodynamics. PATIENTS AND METHODS This single-center retrospective study was conducted in 2507 adult patients undergoing PPGL resections, patients received alpha-adrenergic receptor blockers as a binary variable (selective or non-selective). Propensity score matching was performed and 201 patients were matched successfully. RESULTS A total of 201 patients with PPGL were included in this study. The HI score scores were higher in the selective group than in the non-selective group (60.5 [44.5-84.0] vs 49.0 [37.0-67.25], P=0.027), as well as in the hemodynamic variables section [14.0 [8.0-20.0] vs 10 [6.0-16.0], P=0.009). In terms of specific indicators for each component, the lowest MAP in the selective group (55±10 mmHg vs 59±8 mmHg, P=0.038), the time to MAP below 60 mmHg (0.011% vs 0.022%, P=0.033) and the use of other vasoconstrictors (56.5% vs 35.5%, P=0.019) were significantly lower than in the non-selective group. Among the secondary outcome indicators, the incidence of intraoperative maximum SBP was significantly higher in the selective group than in the non-selective group (32.3% vs 11.3%, P=0.005). There were no significant differences in postoperative outcome indicators between the two groups. CONCLUSION In patients with PPGL, patients prepared preoperatively with non-selective alpha-blockers presented more stable hemodynamics intraoperatively compared to selective alpha1-blockers.
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Affiliation(s)
- Yang Yang
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China,Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jie Zhang
- Department of Anaesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Liqun Fang
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xue Jia
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China,Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Wensheng Zhang
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China,Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China,Correspondence: Wensheng Zhang, Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China, Tel/Fax +81-28-85164144, Email
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Yadav SK, Johri G, Jha CK, Jaiswal SK, Shekhar S, Kumar VV, Mishra SK. Pre-Operative Selective vs Non-Selective α-Blockade in Pheochromocytoma-Paraganglioma Patients Undergoing Surgery: A Meta-Analysis. Indian J Endocrinol Metab 2022; 26:4-12. [PMID: 35662758 PMCID: PMC9162260 DOI: 10.4103/ijem.ijem_469_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
The main objective of this systematic review and meta-analysis was to review, assess and report on the studies that have evaluated selective alpha blockade (SAB) vs. non-selective alpha blockade (NSAB) therapy in patients undergoing surgery for pheochromocytomas and paragangliomas (PPGL). We performed a systematic search of electronic databases. A meta-analysis was conducted to examine the effectiveness of the two blockades. RevMan 5.3 was used for the meta-analysis. Of the eight articles that met the inclusion criteria, there was only one randomized control trial. Meta-analysis showed that there was no significant difference between the groups SAB and NSAB with regard to intra-operative systolic blood pressure (SBP) >160 mm Hg (relative risk (RR) 0.95 [95% CI 0.57, 1.56] P = 0·83) and intra-operative vasopressor requirement (RR 1.10 [95% CI 0.96, 1.26] P = 0·16). Meta-analysis revealed that there was a significant difference between the groups (SAB vs NSAB) with respect to post-operative vasopressor requirement (RR 1.66 [95% CI 1.0, 2.74] P = 0·05). There was no significant difference between the groups with respect to post-operative complications (RR 0.84 [95% CI 0.58, 1.22] P = 0·36). In conclusion, as patients blocked selectively may have a higher incidence of vasodilator requirement intra-operatively, NSAB offers some haemodynamic advantage over SAB. However, NSAB's real clinical benefit cannot be ascertained with the current studies as this difference did not result in any significant advantage over SAB with regard to morbidity or mortality.
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Affiliation(s)
- Sanjay K. Yadav
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Goonj Johri
- Department of Breast Surgery, Wythenshawe Hospital and Nightingale Breast Centre, Manchester University Foundation Trust, United Kingdom
| | - Chandan K. Jha
- Department of Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | - Saket Shekhar
- Department of Biostatistics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Vivek V. Kumar
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Saroj K. Mishra
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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6
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Kong H, Li N, Yang XC, Nie XL, Tian J, Wang DX. Nonselective Compared With Selective α-Blockade Is Associated With Less Intraoperative Hypertension in Patients With Pheochromocytomas and Paragangliomas: A Retrospective Cohort Study With Propensity Score Matching. Anesth Analg 2021; 132:140-149. [PMID: 32675634 PMCID: PMC7717474 DOI: 10.1213/ane.0000000000005070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Both selective and nonselective α-blockade are used for preoperative preparation in patients with pheochromocytomas and paragangliomas (PPGLs). However, the effects of different types of α-blockade on perioperative outcomes remain inconclusive. This study was designed to assess the association between the choice of α-blockade and the amount of intraoperative hypertension in patients undergoing surgery for PPGLs. METHODS: In this propensity-matched retrospective cohort study, data of patients who received either selective or nonselective α-blockade preoperatively and underwent surgery for PPGLs were collected. The primary end point was the time-weighted average above the systolic blood pressure (SBP) of 160 mm Hg (TWA-SBP >160 mm Hg), which was calculated as the total area of the SBP-time curve above the SBP of 160 mm Hg and divided by anesthesia duration. RESULTS: A total of 286 patients were included in analysis; of them, 156 received selective α-blockade and 130 nonselective α-blockade. After propensity score matching, 89 patients remained in each group. Patients who received nonselective α-blockade had a lower TWA-SBP >160 (median 0.472 mm Hg, interquartile range [IQR], 0.081–1.300) versus those who received selective α-blockade (median 1.114 mm Hg, IQR, 0.162–2.853; median difference −0.391, 95% confidence interval [CI], −0.828 to −0.032; P = .016); they also had a lower highest SBP during surgery (193 ± 24 mm Hg versus 205 ± 34 mm Hg; mean difference −12, 95% CI, −20 to −3; P = .008). Postoperative outcomes did not differ significantly between the 2 groups. CONCLUSIONS: For patients undergoing surgery for PPGLs, preoperative nonselective α-blockade was associated with less intraoperative hypertension when compared with selective α-blockade.
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Affiliation(s)
- Hao Kong
- From the Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Nan Li
- From the Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xi-Chun Yang
- From the Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiao-Lu Nie
- Centre for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- From the Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
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7
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Saksa D, Shuch B, Donahue T, Cusumano L, Yu R, Alapag C, Kamdar N. Telemedicine-Based Perioperative Management of Pheochromocytoma in a Patient With Von Hippel Lindau Disease: A Case Report. A A Pract 2021; 15:e01378. [PMID: 33512909 DOI: 10.1213/xaa.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of a young woman with Von Hippel Lindau (VHL) disease who underwent a combined pheochromocytoma resection along with pancreaticoduodenectomy. Her preoperative management, including effective alpha-blockade, was conducted remotely via telemedicine video visits, patient-entered vital sign data, and secure messaging between provider and patient. Similar remote management was undertaken before a subsequent pheochromocytoma resection while the patient was pregnant, and both surgeries had positive outcomes. This represents the first time that telemedicine and mobile health monitoring have been successfully used for preoperative alpha-blockade in a high-acuity patient before a complex multivisceral surgery.
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Affiliation(s)
- Dane Saksa
- From the Department of Anesthesiology and Perioperative Medicine
| | | | | | | | - Run Yu
- Division of Endocrinology, UCLA Health, Los Angeles, California
| | - Catharina Alapag
- From the Department of Anesthesiology and Perioperative Medicine.,Department of Urology.,Department of Surgery.,Department of Radiologyxs.,Division of Endocrinology, UCLA Health, Los Angeles, California
| | - Nirav Kamdar
- From the Department of Anesthesiology and Perioperative Medicine
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8
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Proudman RGW, Pupo AS, Baker JG. The affinity and selectivity of α-adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D-adrenoceptors. Pharmacol Res Perspect 2020; 8:e00602. [PMID: 32608144 PMCID: PMC7327383 DOI: 10.1002/prp2.602] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
α1-adrenoceptor antagonists are widely used for hypertension (eg, doxazosin) and benign prostatic hypertrophy (BPH, eg, tamsulosin). Some antidepressants and antipsychotics have been reported to have α1 affinity. This study examined 101 clinical drugs and laboratory compounds to build a comprehensive understanding of α1-adrenoceptor subtype affinity and selectivity. [3H]prazosin whole-cell binding was conducted in CHO cells stably expressing either the full-length human α1A, α1B, or α1D-adrenoceptor. As expected, doxazosin was a high-affinity nonselective α1-antagonist although other compounds (eg, cyclazosin, 3-MPPI, and ARC239) had higher affinities. Several highly α1A-selective antagonists were confirmed (SNAP5089 had over 1700-fold α1A selectivity). Despite all compounds demonstrating α1 affinity, only BMY7378 had α1D selectivity and no α1B-selective compounds were identified. Phenoxybenzamine (used in pheochromocytoma) and dibenamine had two-component-binding inhibition curves at all three receptors. Incubation with sodium thiosulfate abolished the high-affinity component suggesting this part is receptor mediated. Drugs used for hypertension and BPH had very similar α1A/α1B/α1D-adrenoceptor pharmacological profiles. Selective serotonin reuptake inhibitors (antidepressants) had poor α1-adrenoceptor affinity. Several tricyclic antidepressants (eg, amitriptyline) and antipsychotics (eg, chlorpromazine and risperidone) had high α1-adrenoceptor affinities, similar to, or higher than, α blockers prescribed for hypertension and BPH, whereas others had poor α1 affinity (eg, protriptyline, sulpiride, amisulpiride, and olanzapine). The addition of α blockers for the management of hypertension or BPH in people already taking tricyclic antidepressants and certain antipsychotics may not be beneficial. Awareness of the α-blocking potential of different antipsychotics may affect the choice of drug for those with delirium where additional hypotension (eg, in sepsis) may be detrimental.
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Affiliation(s)
- Richard G. W. Proudman
- Cell Signalling Research GroupDivision of Physiology, Pharmacology and NeuroscienceSchool of Life SciencesC Floor Medical SchoolQueen’s Medical CentreUniversity of NottinghamNottinghamUK
| | - Andre S. Pupo
- Department of PharmacologyInstitute of BiosciencesSão Paulo State UniversityBotucatu‐São PauloBrazil
| | - Jillian G. Baker
- Cell Signalling Research GroupDivision of Physiology, Pharmacology and NeuroscienceSchool of Life SciencesC Floor Medical SchoolQueen’s Medical CentreUniversity of NottinghamNottinghamUK
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9
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Kong H, Li N, Tian J, Bao Z, Liu L, Wu K, Gao Y, Jin B, Zhang Z, Fang D, Zhang J, Zhou L. The use of doxazosin before adrenalectomy for pheochromocytoma: is the duration related to intraoperative hemodynamics and postoperative complications? Int Urol Nephrol 2020; 52:2079-2085. [PMID: 32621102 PMCID: PMC7575471 DOI: 10.1007/s11255-020-02539-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Purpose No conclusion exists for the optimum duration of preoperative administration of doxazosin (DOX) before adrenalectomy for pheochromocytoma. The purpose of this study is to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of DOX administration. Methods In total, 132 patients managed preoperatively with single α-receptor blocker DOX were enrolled. All patients underwent adrenalectomy for pheochromocytoma in the Department of Urology, Peking University First Hospital, between January 2001 and July 2019. Patients were divided into three groups based on the duration of preoperative administration of DOX: group A (≤14 days), group B (15–30 days), and group C (>30 days). Patient and tumor characteristics, intraoperative hemodynamics, and postoperative outcomes were recorded and compared. Results These patients included 57 men and 75 women, with an average age of 48 years. Clinical characteristics, preoperative hemodynamics, medicine management and surgical approaches were comparable between the three groups. Among the three groups, we found that group C (>30 days) had the lowest intraoperative minimum heart rate [group A vs. group B vs. group C = 60 (52–67) vs. 59 (50–61) vs. 51.5 (50–58.75), p = 0.024] and highest risk of postoperative hypotension requiring vasopressor support [group A vs. group B vs. group C = 14 (20.3%) vs. 12 (27.9%) vs. 10 (50.0%), p = 0.032]. Conclusion The current study indicated that preoperative management of pheochromocytoma with single α-receptor blocker DOX for more than 30 days after final dose adjustment might lead to intraoperative bradycardia and more postoperative hypotension requiring vasopressor support. Thus, our study does not support long-term (over 30 days) preoperative administration of pheochromocytoma with single α-receptor blocker DOX in the final dose.
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Affiliation(s)
- Hao Kong
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Nan Li
- Department of Anaesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jie Tian
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhengqing Bao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Lu Liu
- Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Kai Wu
- Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ying Gao
- Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Bo Jin
- Department of Clinical Laboratory, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Dong Fang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,Andrology Center, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
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10
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Fang F, Ding L, He Q, Liu M. Preoperative Management of Pheochromocytoma and Paraganglioma. Front Endocrinol (Lausanne) 2020; 11:586795. [PMID: 33117294 PMCID: PMC7551102 DOI: 10.3389/fendo.2020.586795] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/14/2020] [Indexed: 01/10/2023] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors, characterized by excessive release of catecholamines (CAs), and manifested as the classic triad of headaches, palpitations, profuse sweating, and a variety of other signs and symptoms. The diagnosis of PPGL requires both evidence of excessive release of CAs and anatomical localization of CA-secreting tumor. Surgery is the mainstay of treatment for all patients with PPGL unless contraindicated. However, without proper preparation, the release of excessive CAs, especially during surgery, can result in lethal cardiovascular complications. Herein, we briefly reviewed the pathogenesis of this disease, discussed the current approaches and evidence available for preoperative management, summarizing the results of the latest studies which compared the efficacies of preoperative management with or without α adrenergic-receptor antagonists, aiming to facilitate better understanding of the preoperative management of PPGL for the physicians.
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11
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Chen X, Hu L, Liu C, Ni G, Zhang Y. Tumor characteristics and surgical outcome in incidentally discovered pheochromocytomas and paragangliomas. Endocr Connect 2018; 7:/journals/ec/aop/ec-18-0268.xml. [PMID: 30352413 PMCID: PMC6215805 DOI: 10.1530/ec-18-0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/07/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The proportion of incidentally discovered pheochromocytomas and paragangliomas(PPGL) has increased over time. However, our knowledge of them is quite limited. The purpose of this retrospective study is to generalize the commonalities in incidentally discovered PPGL, offer evidences for clinical diagnosis and management. METHODS 526 patients were included in our study after filtration from the database of West China Hospital of Sichuan University between May, 2007 and December, 2016.Among the patients, 148 of them were incidental findings and 378 of them were suspected findings. All patients' demography and tumor characteristics were recorded in detail, especially hemodynamic records and hormonal assays. The reasons for taking radiography were also collected. Most patients received preoperative medical preparation . Intraoperative and postoperative courses as well as surgical outcomes were also analyzed to identify differences between incidental findings and suspected findings. RESULTS Incidentally discovered PPGL took up 28.1% of the study population. Suspected PPGLs had a higher prevalence of hypertension, lower proportion of non-functioning PPGL, higher prevalence of MEN2 and better post-surgical blood pressure recovery than incidental finding group. However, patients in the incidental finding group showed no significant difference in preoperative blood pressure and hormonal assays with suspected findings in metaphrine and normetaphrine in plasma and urine (P>0.05). CONCLUSIONS Due to the development of technology, more PPGLs are discovered incidentally. Considering the tumor characteristics and surgical outcome, surgical decisions should be made more cautiously.
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Affiliation(s)
- Xinlei Chen
- Department of Endocrinology and MetabolismWest China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liru Hu
- Department of Endocrinology and MetabolismWest China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Caojie Liu
- Department of Endocrinology and MetabolismWest China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Guangcheng Ni
- Department of Endocrinology and MetabolismWest China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuwei Zhang
- Department of Endocrinology and MetabolismWest China Hospital of Sichuan University, Chengdu, Sichuan, China
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