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Thosani S, Ayala-Ramirez M, Román-González A, Zhou S, Thosani N, Bisanz A, Jimenez C. Constipation: an overlooked, unmanaged symptom of patients with pheochromocytoma and sympathetic paraganglioma. Eur J Endocrinol 2015; 173:377-87. [PMID: 26060051 DOI: 10.1530/eje-15-0456] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/09/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pheochromocytomas (PHs) and sympathetic paragangliomas (PGs) are tumors that produce catecholamines, predisposing patients to cardiovascular disease and gastrointestinal effects such as constipation. OBJECTIVES i) determine the prevalence of constipation, its risk factors, and its impact on survival; ii) identify whether a systematic combination of fiber, water, and laxatives was effective for treatment of constipation. DESIGN AND METHODS We retrospectively studied 396 patients with PH/PG diagnosed in 2005-2014. The study population was patients with constipation as a presenting symptom; the control group was patients without constipation as a presenting symptom. The MD Anderson Symptom Inventory was used to assess constipation and quality of life. RESULTS Twenty-three patients (6%) had constipation. Constipation was associated with headaches, palpitations, diaphoresis, weight loss, and excessive noradrenaline production (P<0.0001). Eighteen of these patients had non-metastatic primary tumors larger than 5 cm and/or extensive metastases. No statistically significant differences in age, sex, and genotype were noted between the study and control groups. In patients without metastases, resection of the primary tumor led to symptom disappearance. A systematic combination of fiber, water, and laxatives was associated with symptom improvement. Two patients who presented unmanaged constipation died because of sepsis from toxic megacolon. CONCLUSIONS Constipation is a rare and potentially lethal complication in patients with PH/PGs. Severe constipation can be prevented by recognizing and treating mild symptoms.
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Affiliation(s)
- Sonali Thosani
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Montserrat Ayala-Ramirez
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alejandro Román-González
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shouhao Zhou
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nirav Thosani
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Annette Bisanz
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Pola S, Patel D, Ramamoorthy S, McLemore E, Fahmy M, Rivera-Nieves J, Chang JT, Evans E, Docherty M, Talamini M, Sandborn WJ. Strategies for the care of adults hospitalized for active ulcerative colitis. Clin Gastroenterol Hepatol 2012; 10:1315-1325.e4. [PMID: 22835577 PMCID: PMC4226798 DOI: 10.1016/j.cgh.2012.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/15/2012] [Accepted: 07/11/2012] [Indexed: 02/07/2023]
Abstract
Ulcerative colitis is a chronic inflammatory disease of the colon; as many as 25% of patients with this disease require hospitalization. The goals of hospitalization are to assess disease severity, exclude infection, administer rapidly acting and highly effective medication regimens, and determine response. During hospitalization, patients should be given venous thromboembolism prophylaxis and monitored for the development of toxic megacolon. Patients who do not respond to intravenous corticosteroids should be considered for rescue therapy with infliximab or cyclosporine. Patients who are refractory to medical therapies or who develop toxic megacolon should be evaluated promptly for colectomy. Patients who do respond to medical therapies should be discharged on an appropriate maintenance regimen when they meet discharge criteria. We review practical evidence-based management principles and propose a day-by-day algorithm for managing patients hospitalized for ulcerative colitis.
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Affiliation(s)
- Suresh Pola
- Inflammatory Bowel Disease Center, Division of Gastroenterology, University of California San Diego Health System, La Jolla, CA, USA
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