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Zhao L, Chen M, Chen X, Yu L, Du SG, Gan Q, Yang WZ, Jiang C, Xiao M. Ectopic pheochromocytomas in the third trimester: A case report and literature review. Medicine (Baltimore) 2024; 103:e36127. [PMID: 38306535 PMCID: PMC10843473 DOI: 10.1097/md.0000000000036127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/25/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION To investigate the clinical features, pregnancy care, timing, and approaches of pregnancy termination as well as the perinatal management of pregnant women with ectopic pheochromocytomas (EPCC) (paragangliomas, PGL). METHODS We report the diagnosis and treatment of a pregnant women with EPCC which was confirmed in the third trimester in our hospital. Literature in relation to EPCC during pregnancy both in and outside China was searched for data analysis such as maternal clinical features and maternal and fetal prognosis. RESULTS A total of 20 papers including 21 cases (plus ours) were retrieved. The average age of pregnant patients was 28 years old (from 21 to 37). Two patients presented no hypertension. Nineteen had hypertension in various extent with the accompany of headache (11 cases, 57.9%), palpitations (8 cases, 42.1%), sweating (6 cases, 31.6%), nausea (6 cases), abdominal pain (2 cases), etc. The tumor was found in the chest in 3 patients, in the upper abdomen in 1 patient, in the middle abdomen in 10 patients, between the lower abdomen and pelvic cavity in 3 patients and in the pelvic cavity in 3 patients. Five patients had a surgical removal of the tumor before delivery, 3 during cesarean section and 10 after giving birth. CONCLUSION EPCC (PGL) during pregnancy is a rare extra-adrenal tumor, whose manifestations are often confused with those of pregnancy-induced hypertension. It is extremely hard to diagnosis the disease before surgery. Patients still have an opportunity of undergoing spontaneous delivery if their tumors have been removed before labor. However, for patients whose pheochromocytomas is localized before labor, it is better to terminate their pregnancy via cesarean section in a proper time according to their obstetric conditions, while under the supervision of multidisciplinary specialists. The preparations of both α and β adrenergic receptor blocker treatment that is normally carried out before PGL removal surgery are unnecessary to be overemphasized before the cesarean section.
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Affiliation(s)
- Lei Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Miaomiao Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiaohong Chen
- Department of Internal Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ling Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Shu Guo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Quan Gan
- Department of Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Wen Zhong Yang
- Department of Medical Imaging, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Chengcheng Jiang
- Department of Medical Imaging, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Mei Xiao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Abstract
While most adrenal tumors are identified incidentally and are non-functional, hormone-secreting tumors can cause morbidity and mortality. Hemodynamic lability and hypertension in pregnancy are associated with worse maternal and fetal outcomes. Achieving a diagnosis of hormone excess due to adrenal tumors can be clinically more difficult in the gravid patient due to normal physiologic alterations in hormones and symptoms related to pregnancy. This review focuses on some nuances of the diagnostic work-up, perioperative care, and surgical management of adrenally-mediated cortisol excess, primary aldosteronism, and pheochromocytoma and paraganglioma in the pregnant patient.
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Affiliation(s)
| | - Sophie Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Champion NT, Monasterio D, Mukherjee I, Picon A. Robotic-assisted left adrenal cystic mass excision in a pregnant patient. BMJ Case Rep 2022; 15:e245954. [PMID: 35649621 PMCID: PMC9161104 DOI: 10.1136/bcr-2021-245954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/04/2022] Open
Abstract
A symptomatic adrenal mass diagnosed during pregnancy is a rare clinical scenario. Two primary considerations are the timing of intervention and determining the appropriate surgical approach. Here, we present the case of a young female patient with flank pain, whom on diagnostic imaging, was found to have a large cystic adrenal mass. She was taken for a robotic-assisted resection of her left-sided adrenal mass during the second trimester of pregnancy. Preoperative and postoperative assessment demonstrated a viable intrauterine pregnancy. She tolerated the procedure well and was discharged 5 days later with resolution of her symptoms on follow-up. As one of only three reported cases of robotic adrenal surgery during pregnancy, we demonstrate that a robotic-assisted surgical approach is a viable and durable surgical option under the given clinical circumstances.
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Affiliation(s)
| | - Diego Monasterio
- Surgery, Staten Island University Hospital, Staten Island, New York, USA
| | | | - Antonio Picon
- Surgery, Stamford Health Medical Group, Stamford, Connecticut, USA
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Abstract
PURPOSE OF REVIEW Pheochromocytoma and paraganglioma (PPGL) in pregnancy is a rare entity and management of these patients is fraught with uncertainty. Our objective is to review current literature and discuss diagnosis and management of these patients. RECENT FINDINGS Outcomes of PPGL in pregnancy have improved in recent years. The greatest risk for adverse maternal and fetal outcomes is the diagnosis of PPGL after delivery. Alpha- and beta-adrenergic blockade is well tolerated and is associated with less adverse outcomes. Antepartum surgery is not associated with improved maternal or fetal outcomes. Biochemical testing and cross-sectional imaging should be performed prior to conception for patients with a known germline variant associated with PPGL. CONCLUSIONS Medical therapy should be initiated when PPGL is diagnosed in pregnancy. Antepartum surgery should be reserved for special circumstances. Case detection testing in high-risk patients can identify PPGL before pregnancy.
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Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology 2020; 151:58-66. [PMID: 32445766 DOI: 10.1016/j.urology.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022]
Abstract
Urologic and gynecologic surgeons are the top utilizers of robotic surgery; however, nonobstetrical robotic-assisted laparoscopic surgery (RALS) in pregnant patients is infrequent. A systematic literature review was performed to ascertain the frequency, indication and complications of RALS in pregnancy. Results showed 38 pregnancies from eleven publications between 2008 and 2020. Five cases were for urologic indication and 33 for gynecologic indication. Minimal surgical alterations were required. Although no adverse maternal-fetal outcomes were reported, there are not enough cases published to determine safety. This review demonstrates the feasibility of RALS for the pregnant population in the hands of competent robotic surgeons.
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Affiliation(s)
- Courtney E Capella
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Joseph Godovchik
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Huda B Al-Kouatly
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Chu PY, Burks ML, Sólorzano CC, Bao S. ROBOTIC PARAGANGLIOMA RESECTION IN A PREGNANT PATIENT. AACE Clin Case Rep 2020; 6:e197-e200. [PMID: 32984520 DOI: 10.4158/accr-2019-0558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/07/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Functional paragangliomas in pregnancy are rare; however, if not recognized and treated early, they can be life-threatening. New treatment approaches with robotic resection are promising. Methods We present a case of a pregnant female with a paraganglioma which was successfully resected during the second trimester using Da Vinci Xi robotic system. Paraganglioma was diagnosed with plasma and urinary catecholamines and metanephrines, a contrast computed tomography (CT) scan, and confirmed with surgical pathology. Results The patient was initially seen in the emergency room prior to the index pregnancy for nausea, vomiting, and intermittent, left lower quadrant abdominal pain, episodic sweating, palpitations, and anxiety. CT scan of the abdomen and pelvis showed a 4.8 × 4.3 cm heterogeneously enhancing mass in the left retroperitoneum adjacent to the aorta just below the left adrenal gland. She had normal plasma metanephrines but elevated plasma normetanephrines of 7.12 nmol/L (normal, <0.89 nmol/L). Twenty-four-hour urine norepinephrine and catecholamines were elevated to 604 μg (normal, <90 μg/24 hours) and 610 μg (normal, <115 μg/24 hours), respectively. Chromogranin A was elevated to 940 ng/mL (normal, 0 to 95 ng/mL). Paraganglioma was suspected. Doxazosin was started for blood pressure control. The patient became pregnant unexpectedly shortly after. She was managed by a multidisciplinary team. At 18 weeks of pregnancy, she underwent a transabdominal robotic resection of the left retroperitoneal paraganglioma with an excellent outcome. Conclusion Functional paragangliomas in pregnancy are rare but must be recognized and treated early to reduce maternal and fetal complications. An innovative robotic approach should be considered and explored.
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Affiliation(s)
- Patricia Y Chu
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret L Burks
- Division of Endocrinology, Department of Internal Medicine, Vanderbilt University, Nashville, Tennessee
| | - Carmen C Sólorzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt Endocrine Surgery Center, General Surgery, VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shichun Bao
- Division of Endocrinology, Department of Internal Medicine, Vanderbilt University, Nashville, Tennessee
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Capella CE, Chandrasekar T, Counsilman M, Sebastiano C, Lallas CD, Al-Kouatly HB. Robotic Adrenalectomy for Functional Adenoma in Second Trimester Treats Worsening Hypertension. Urology 2020; 151:67-71. [PMID: 32360626 DOI: 10.1016/j.urology.2020.04.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/29/2020] [Accepted: 04/19/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Courtney E Capella
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - MayJean Counsilman
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Christopher Sebastiano
- Department of Pathology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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E Paula FDA, Dos Santos RI, Ferruzzi OA, Melo RO, Takaku M. Laparoscopic approach to pheochromocytoma in pregnancy: case report. Int Braz J Urol 2018; 44:629-633. [PMID: 29412551 PMCID: PMC5996791 DOI: 10.1590/s1677-5538.ibju.2017.0540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022] Open
Abstract
A 32-year-old 22-week pregnant hypertensive woman with sporadic episodes of headaches, sweating, and facial flushing was diagnosed with pheochromocytoma through biochemical and imaging tests. Perioperative management included a multidisciplinary approach, symptom stabilization with α blockade followed by β blockade, and tumor resection by laparoscopic adrenalectomy at 24 weeks gestation. The diagnosis was confirmed by histopathological examination and immuno-histochemistry tests. The decision for surgical removal of the tumor was based on maternal symptoms, tumor size, gestational age, the possibility of doing a laparos-copy, and the expertise of the surgical team.
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Affiliation(s)
- Felipe de Almeida E Paula
- Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil.,Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil.,Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil
| | - Ravisio Israel Dos Santos
- Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil.,Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil.,Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil
| | | | - Rafael Osti Melo
- Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil
| | - Mariana Takaku
- Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil.,Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil
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Yiannakopoulou E. Robotic assisted adrenalectomy: Surgical techniques, feasibility, indications, oncological outcome and safety. Int J Surg 2016; 28:169-72. [DOI: 10.1016/j.ijsu.2016.02.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/17/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
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10
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Prete A, Paragliola RM, Salvatori R, Corsello SM. MANAGEMENT OF CATECHOLAMINE-SECRETING TUMORS IN PREGNANCY: A REVIEW. Endocr Pract 2015; 22:357-70. [PMID: 26536138 DOI: 10.4158/ep151009.ra] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Catecholamine-secreting tumors (pheochromocytomas and paragangliomas) presenting during pregnancy are extremely rare, but they can be fatal to both mother and fetus. Recent discoveries in the genetic background of these tumors are expected to address an increasing number of at-risk women to prenatal diagnosis. METHODS The literature was reviewed in order to provide clinicians with a practical and updated guide on how to manage this life-threatening condition. RESULTS The clinical presentation of catecholamine-secreting tumors can be deceptive and mimic common disorders of pregnancy. Silent catecholamine-secreting tumors can become evident during pregnancy, and hypertension cannot be considered a hallmark for this condition: some women may be normotensive or develop orthostatic hypotension. Biochemical screening includes measurement of plasma free metanephrines or urinary fractioned metanephrines. Measurement of catecholamines, dopamine, and methoxytyramine can provide further information on tumor biology, location, and prognosis. Diagnostic imaging is limited, and medical treatment requires a cautious balance between hemodynamic control and effects on the fetoplacental unit. Several genes have been associated with syndromes including catecholamine-secreting tumors, and positive genetic testing can correlate with tumor behavior. Timing and modalities for tumor removal and delivery, including anesthetic management, depend on gestational age, maternal and fetal wellbeing, control of catecholamine excess, suspicion of multiple or malignant disease, and surgical accessibility to the tumor. CONCLUSION A timely diagnosis and a multidisciplinary approach are the keys to improve pregnancy outcomes in patients with a catecholamine-secreting tumor; each case should be managed in a tertiary referral center.
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11
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Okoh AK, Berber E. Laparoscopic and robotic adrenal surgery: transperitoneal approach. Gland Surg 2015; 4:435-41. [PMID: 26425457 PMCID: PMC4561658 DOI: 10.3978/j.issn.2227-684x.2015.05.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/03/2015] [Indexed: 12/27/2022]
Abstract
Recent advances in technology and the need to decrease surgical morbidity have led a rapid progress in laparoscopic adrenalectomy (LA) over the past decade. Robotics is attractive to the surgeon owing to the 3-dimensional image quality, articulating instruments, and stable surgical platform. The safety and efficacy of robotic adrenalectomy (RA) have been demonstrated by several reports. In addition, RA has been shown to provide similar outcomes compared to LA. Development of adrenal surgery has involved the description of several surgical approaches including the anterior transperitoneal, lateral transperitoneal (LT) and posterior retroperitoneal (PR). Among these, the most frequently preferred technique is LT adrenalectomy, primarily due to the surgeon's familiarity of the operative field, wider working space and visibility. The LT technique is suitable for the resection of larger, unilateral tumors and in scenarios where conversion to an open transperitoneal approach is warranted, it offers a lesser burden. Also, the larger view of the entire abdominal cavity and excellent exposure of both adrenal glands and surrounding structures provided by the LT technique render it safe and feasible in pediatric and pregnant individuals.
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Affiliation(s)
- Alexis K Okoh
- Department Of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Eren Berber
- Department Of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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12
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Dealing with Pheochromocytoma during the First Trimester of Pregnancy. Case Rep Obstet Gynecol 2015; 2015:439127. [PMID: 25838955 PMCID: PMC4369956 DOI: 10.1155/2015/439127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.
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Memon MA, Aziz W, Abbas F. Surgical management of pheochromocytoma in a 13-week pregnant woman. BMJ Case Rep 2014; 2014:bcr-2013-202838. [PMID: 24850551 DOI: 10.1136/bcr-2013-202838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 34-year-old 13-week pregnant woman presented with hypertension refractory to medical therapy and on workup was found to have a right adrenal mass. Due to her persistent increased blood pressure she was advised urinary vanillylmandelic acid (VMA) and its level was raised. MRI of the abdomen showed a well-circumcised lesion in the right adrenal of 3.0×2.5 cm suggestive of pheochromocytoma. The patient was started on antihypertensives including α-blockers and β-blockers and planned for right open adrenalectomy. Intraoperatively, blood pressure was raised up to 180/110 mm Hg on slight manipulation of adrenal gland which was controlled with glyceryl-trinitrate and volatile agents. Postoperatively urinary VMA decreased to normal range and all antihypertensives were gradually stopped. She had uneventful pregnancy and delivered vaginally. This case report highlights the importance of surgical management of pheochromocytoma in second trimester of pregnancy to avoid catastrophic complications later in pregnancy.
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Affiliation(s)
- Mazhar Ali Memon
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Wajahat Aziz
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Farhat Abbas
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
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15
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Abstract
Abstract
Background
Phaeochromocytoma in pregnancy is a rare and potentially dangerous situation for mother and fetus. This review aimed to assess current mortality rates and how medical and surgical management affect these.
Methods
Articles in English published between 2000 and 2011 were obtained from a MEDLINE search. Eligible publications presented women diagnosed with phaeochromocytoma in the antenatal or immediate postnatal period, and reported management and outcomes.
Results
A total of 135 reports were identified. After applying inclusion criteria, 77 pregnancies involving 78 fetuses were analysed. Fetal and maternal mortality rates were 17 per cent (13 of 78) and 8 per cent (6 of 77) respectively. Better outcomes were achieved when the diagnosis of phaeochromocytoma was made in the antenatal period than when it was made during labour or immediately postpartum (survival of both mother and fetus(es) in 48 of 56 versus 12 of 21 respectively; P = 0·012). When the diagnosis was made before 23 weeks' gestation, there was no difference in outcomes when phaeochromocytoma surgery was carried out in the second trimester, compared with when it was postponed to the third trimester or after delivery (fetal death 2 of 18 versus 2 of 8 respectively; P = 0·563).
Conclusion
This review, although limited by the rarity of the condition and level of available evidence, demonstrated that survival rates are improved if the diagnosis of phaeochromocytoma can be established antenatally. With diagnosis before 23 weeks' gestation, no definite advantage of proceeding with tumour removal during the second trimester could be demonstrated.
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Affiliation(s)
- M A Biggar
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - T W J Lennard
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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D'Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G, Mazzocchi P, Pende V. Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot 2012; 8:483-90. [DOI: 10.1002/rcs.1454] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Annibale D'Annibale
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Giorgio Lucandri
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Igor Monsellato
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Monica De Angelis
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Graziano Pernazza
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Giovanni Alfano
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Paolo Mazzocchi
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
| | - Vito Pende
- Minimally Invasive and Robotic Surgical Unit; San Giovanni-Addolorata Hospital; Rome Italy
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18
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Current World Literature. Curr Opin Oncol 2012; 24:109-14. [DOI: 10.1097/cco.0b013e32834f4ea3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Curcillo PG, Wu AS, Podolsky ER, King SA. [Reduced port surgery : Developing a safe pathway to single port access surgery]. Chirurg 2011; 82:391-7. [PMID: 21560056 DOI: 10.1007/s00104-010-2003-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
"Scarfree" surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental.
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Affiliation(s)
- P G Curcillo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Hoover K, Jenkins TR. Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 2011; 205:97-102. [PMID: 21571247 DOI: 10.1016/j.ajog.2011.01.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/18/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
With widespread use of ultrasound in early pregnancy, incidental adnexal masses are detected frequently. This article reviews the differential diagnosis, appropriate evaluation, and current treatment options for adnexal masses in pregnancy. With the increased sophistication of ultrasound, observation has become a more viable option. However, for those masses suspicious for malignancy, at risk for torsion, or clinically symptomatic, surgical management is warranted. With increasing numbers of successful laparoscopic procedures reported in pregnancy, laparoscopy appears to be a safe option with trained and experienced providers.
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Genc V, Agcaoglu O, Berber E. Robotic endocrine surgery: technical details and review of the literature. J Robot Surg 2011; 6:85-97. [PMID: 27628272 DOI: 10.1007/s11701-011-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022]
Abstract
Over the last decade, robotic technology has been used in multiple general surgical procedures. Endocrine surgeons have embraced this technology and subsequently transformed neck operations into more cosmetically acceptable procedures and improved ergonomics. Technical details of various robotic endocrine surgical procedures have recently been described. The aim of this review is to illustrate these technical details and analyze the current data to propose an evidence-based approach to robotic endocrine surgery.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Agcaoglu
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA
| | - Eren Berber
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
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Abstract
PURPOSE OF REVIEW To summarize the recent developments in minimally invasive adrenal surgery. RECENT FINDINGS Modern adrenal surgery continues to evolve with new techniques. Both the laparoscopic transabdominal and retroperitoneoscopic approaches are now the standard of care for the removal of nonmalignant adrenal tumors. Other recent developments include robotic retroperitoneal adrenalectomy, single-incision laparoendoscopic surgery, and ambulatory adrenalectomy. SUMMARY Here, we review the literature of minimally invasive adrenal surgery over the last year to highlight new developments and technical refinements.
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Affiliation(s)
- Matthew A Nehs
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2011; 18:231-4. [PMID: 21844704 DOI: 10.1097/med.0b013e3283473d73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Moinzadeh A, Gill IS. Robotic adrenalectomy. J Surg Oncol 2005; 106:622-5. [PMID: 15474602 DOI: 10.1002/jso.23132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 03/27/2012] [Indexed: 12/13/2022]
Abstract
The use of robotics in surgery is an emerging field. Robot-assisted laparoscopic adrenalectomy has been performed in small numbers worldwide. Advantages of robotic assistance over conventional laparoscopy are not acknowledged. Improvement in robotic technology, including addition of tactile feedback, miniaturization of end-effectors, reduced cost, and advances in remote surgery telecommunication technology are awaited.
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Affiliation(s)
- Alireza Moinzadeh
- Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195, USA
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