National Cancer Institute®
Last Modified: January 1, 2002
UI - 11403350
AU - Gardet V; Gatta B; Simonnet G; Tabarin A; Chene G; Ducassou D; Corcuff
TI - JB Lessons from an unpleasant surprise: a biochemical strategy for the diagnosis of pheochromocytoma.
SO - J Hypertens 2001 Jun;19(6):1029-35
AD - Department of Nuclear Medicine, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
OBJECTIVE: To audit the performances of the analytes used in the diagnosis of pheochromocytoma and to present a graphical guideline to help the diagnosis. DESIGN: A 5 year retrospective study. SETTINGS: Laboratory and departments of a university hospital. PARTICIPANTS: In-patients, suspected of bearing a pheochromocytoma, were investigated for urinary metanephrines and catecholamines (photometric method) and vanillylmandelic acid, fractionated catecholamines and metanephrines [high pressure liquid chromatography (HPLC) coupled to electrochemical detection (ED)] urinary excretion. MAIN OUTCOME: Patients with a pheochromocytoma (24 out of 2003 patients) were diagnosed by the combination of normetanephrine and metanephrine determination. RESULTS: All analytes but dopamine were significantly elevated in patients with a pheochromocytoma. The area under the receiver operating characteristics (ROC) curves were the highest for total metanephrines, normetanephrine and metanephrine determinations. Because of analytical interferences in the metanephrines determination, the normetanephrine and metanephrine performed better. It is noteworthy that all pheochromocytomas had either normetanephrine or metanephrine levels above their respective optimal threshold (sensitivity 100%). The best optimal threshold performance was reached by the mean of three daily samples. Total or fractionated catecholamines or vanillylmandelic acid were less accurate tools. CONCLUSION: Amongst urinary tests, the combined use of HPLC/ED determination of normetanephrine and metanephrine seems the most effective screening strategy for the diagnosis of pheochromocytoma. The older total metanephrine photometric assay is grieved by analytical interferences.
UI - 11440275
AU - Letizia C; De Toma G; Caliumi C; Cerci S; Massa R; Loria RD; Alo P;
TI - Marinoni EM; Diacinti D; D'Erasmo E Plasma adrenomedullin concentrations in patients with adrenal pheochromocytoma.
SO - Horm Metab Res 2001 May;33(5):290-4
AD - Department of Clinical Science, University La Sapienza, Rome, Italy. firstname.lastname@example.org
BACKGROUND: The hypotensive peptide adrenomedullin was first isolated in extracts of human pheochromocytoma. There is, however, no information available on the behaviour of circulating adrenomedullin or on the correlation with catecholamines in patients with pheochromocytoma. OBJECTIVES: 1) to investigate whether plasma adrenomedullin levels were changed in 10 patients with pheochromocytoma when compared to 21 healthy subjects and 16 patients with essential hypertension; 2) to determine whether or not adrenomedullin has a counter-regulatory role in catecholamine excess in pheochromocytoma or is responsible for hemodynamic modifications before and after tumour resection; 3) to determine tissue distribution of iradrenomedullin in the pheochromocytoma. METHODS: Plasma adrenomedullin and catecholamine levels were measured in all patients with pheochromocytoma before and four weeks after tumour removal. In the four patients undergoing resection of tumours, plasma levels of adrenomedullin were measured at different time-points during surgery. RESULTS: The mean plasma adrenomedullin concentrations ( SD) in patients with pheochromocytoma (37.9 +/- 6pg/ml) were significantly higher (p<0.0001) than those in normal subjects (13.7 +/- 6.1 pg/mI) and patients with essential hypertension (22.5 +/- 9.lpg/ml). Adrenomedullin levels correlated with plasma noradrenaline (r = 0.516, p = 0.0124). In all patients with pheochromocytoma, plasma adrenomedullin concentrations decreased after removal of tumours (from 37.9 +/- 6 to 10.9 +/- 4.6 pg/ml; p < 0.0001). In the four patients studied during surgery, baseline plasma adrenomedullin and noradrenaline levels were markedly elevated, and increased significantly with tumour manipulation, decreasing 24 hours after operation. Adrenal medulla cells surrounding the pheochromocytoma site stained for ir-adrenomedullin, whereas only isolated cells of pheochromocytoma stained for the peptide. CONCLUSIONS: This study demonstrates that circulating adrenomedullin is increased in pheochromocytoma, and is also correlated with plasma noradrenaline levels. Adrenomedullin may represent an additional biochemical parameter for clinical monitoring of patients with pheochromocytoma.
UI - 11443849
AU - Gimm O
TI - Multiple endocrine neoplasia type 2: clinical aspects.
SO - Front Horm Res 2001;28():103-30
AD - Department of General Surgery, Martin-Luther-University, Halle-Wittenberg, Germany. email@example.com
UI - 11444194
AU - Garcia-Escudero A; de Miguel-Rodriguez M; Moreno-Fernandez A;
TI - Navarro-Bustos G; Galera-Ruiz H; Galera-Davidson H Prognostic value of DNA flow cytometry in sympathoadrenal paragangliomas.
SO - Anal Quant Cytol Histol 2001 Jun;23(3):238-44
AD - Department of Pathology, University Hospital Virgen Macarena, Seville, Spain.
OBJECTIVE: To determine whether ploidy patterns are related to prognosis in sympathoadrenal paragangliomas (SAP) using flow cytometry. STUDY DESIGN: DNA flow cytometric analysis of formalin-fixed, paraffin-embedded tumor samples from 36 patients with SAP was performed. Eight cases fulfilled at least one of the following malignancy criteria: (1) extensive invasion of adjacent structures (5 cases), (2) local recurrence (3 cases), or (3) metastases (4 cases). RESULTS: Of the 36 tumors, 22 (61%) showed nondiploid patterns (12 aneuploid, 10 tetraploid). All diploid tumors were benign, while all malignant cases showed nondiploid patterns (P = .0131). The differences between diploid and aneuploid tumors and between diploid and tetraploid tumors, with regard to the malignancy of the disease, were statistically significant (P = .03311 and .01976, respectively). Only one malignant tumor had a DNA index < 1.75 (P = .00259). CONCLUSION: Anomalous DNA ploidy patterns are frequent in SAP, without necessarily implying malignancy. However, diploid DNA content may be a marker of a good prognosis. The likelihood of malignancy is greater in the tetraploid and peritetraploid range.
UI - 11465661
AU - Diamond JA
TI - Pheochromocytoma in a symptomatic patient with severe hypertension upon anesthesia induction.
SO - Am J Hypertens 2001 Jul;14(7 Pt 1):729-30
AD - Mount Sinai School of Medicine, New York, New York 10029, USA.
UI - 11456261
AU - Glodny B; Winde G; Herwig R; Meier A; Kuhle C; Cromme S; Vetter H
TI - Clinical differences between benign and malignant pheochromocytomas.
SO - Endocr J 2001 Apr;48(2):151-9
AD - Institute of Pharmaceutical Biology and Phytochemistry, Westfalische Wilhelms-Universitat Munster, Germany.
Most pheochromocytomas can be cured by resection. In view of the unfavourable prognosis for surgical therapy in cases of late tumour detection and malignant tumours, the aim of the present study is to differentiate between typical signs and symptoms of malignant versus benign pheochromocytomas. We investigated the records of 133 patients retrospectively (1967-1998). In cases of benign tumours (104 of 133, mean age 42+/-15.8 years) tumour size was 5.9+/-3.4 cm, and history was 47.4+/-75.4 months. 7.7% of the tumours were extraadrenal, and 77% had paroxysmal manifestations. The other 29 patients (mean age: 39.2+/-21.9 years) had malignant lesions (tumour size: 9.4+/-5.9 cm (p=0.0022); history: 7.4+/-5.6 months (p=0.0137); extraadrenal: 24.1% (p=0.0219); paroxysmal: 37.9% (p=0.0012)). Symptoms of patients with benign tumours were hypertension (80%), headaches (42.3%), sweating (30.8%), tachycardia (26%) and pallor (24%) (Malignant: Hypertension 46%, p=0.0873; headaches 11%, p=0.0008; sweating 11%, p=0.0196; tachycardia 14%, p=0.1961 and pallor 0%, p=0.0010). Abdominal pain and dorsalgia occurred more frequently in malignant pheochromocytomas (26% versus 7%, p=0.0014). Unusually short histories and extraadrenal localization appear to be suspicious for malignancy. The "typical" clinical signs and symptoms occur more frequently in patients with benign tumours and can therefore be regarded as typical signs of benign pheochromocytomas.
UI - 11475579
AU - Frenzel S; Apel TW; Heidemann PH; Zerres K; Neumann HP; Dorr HG
TI - Phaeochromocytoma associated with a de novo VHL mutation as form fruste of von Hippel-Lindau disease.
SO - Eur J Pediatr 2001 Jul;160(7):421-4
AD - Division of Paediatric Endocrinology, University Hospital for Children and Adolescents, Loschgestrasse 15, 91054 Erlangen, Germany. HGDoerr@kinder.imed.uni-erlangen.de
Phaeochromocytomas usually occur sporadically but may be associated with dominant inherited cancer syndromes such as multiple endocrine neoplasia type 2 (MEN 2), von Hippel-Lindau disease (VHL) and type 1 neurofibromatosis. We report on a boy presenting at age 8 years with an isolated benign phaeochromocytoma of the left adrenal. Three years later a second adrenal phaeochromocytoma was diagnosed on the right side and removed. His family history was negative. Genetic analysis did not show a mutation in the MEN 2 susceptible proto-oncogene rearranged during transfection; however, we found a germline missense mutation in the VHL gene (nucleotide 695 G to A transversion) which has been described only twice before in the literature. Both parents had normal (wild type) VHL copies indicating that our patient had a de novo germline VHL mutation. Careful clinical evaluation of the patient at 18 years did not reveal any other manifestations of VHL disease. CONCLUSION: Carriers of von Hippel-Lindau germline mutations can present with a form fruste of von Hippel-Lindau disease presenting initially with unilateral phaeochromocytoma and therefore mutation analysis should be carried out.
UI - 11573274
AU - Yoshida K; Tatsukawa H; Ashida K; Matsubara K; Kubota Y; Uwatoko H;
TI - Ogasawara H; Katsuma Y; Kitamura K [Pheochromocytoma with severe paralytic ileus occurred from acute pulmonary edema caused by metoclopramide]
SO - Nippon Naika Gakkai Zasshi 2001 Aug 10;90(8):1522-4
AD - Department of Internal Medicine, Kyoto City Hospital, Kyoto.
UI - 11547079
AU - Anderson MI; O'Reilly KJ; Costabile RA
TI - Retroperitoneal bronchogenic cyst mimicking a pheochromocytoma.
SO - J Urol 2001 Oct;166(4):1379-80
AD - Urology Service, Department of Surgery, Madigan Army Medical Center, Ft. Lewis, Washington, USA.
UI - 11560309
AU - Godfrey JA; Rickman OB; Williams AW; Thompson GB; Young WF Jr
TI - Pheochromocytoma in a patient with end-stage renal disease.
SO - Mayo Clin Proc 2001 Sep;76(9):953-7
AD - Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Pheochromocytoma is a rare tumor. To our knowledge only 15 cases have been reported in patients with end-stage renal disease (ESRD). We describe a 46-year-old woman with ESRD and a history of paroxysmal and difficult-to-control hypertension. During anesthesia for a surgical procedure, the patient experienced blood pressure lability with systolic blood pressures ranging from 76 to 360 mm Hg. Serum catecholamine concentrations were 2,698 pg/ mL (reference value, <750 pg/mL) for norepinephrine, 33 pg/mL (<110 pg/mL) for epinephrine, and 55 pg/mL (<30 pg/mL) for dopamine. The concentrations of plasma metanephrines were 6.84 nmol/L (<0.50 nmol/L) for metanephrine and 14.64 nmol/L (<0.90 nmol/L) for normetanephrine. Abdominal computed tomography showed a right-sided, 4-cm mass posterior to the infrahepatic inferior vena cava. Following blood pressure control with alpha- and beta-adrenergic blockade, the mass was removed. Pathologic examination demonstrated the mass was a pheochromocytoma. The maximum postoperative systolic blood pressure was 160 mm Hg. Postoperative plasma normetanephrine concentration was 2.80 nmol/L, and metanephrine was obscured by interfering substances. This case report and literature review emphasizes the difficulty in diagnosing pheochromocytomas in patients with ESRD despite the myriad of available diagnostic tests.
UI - 11575354
AU - Atallah F; Bastide-Heulin T; Soulie M; Crouzil F; Galiana A; Samii K;
TI - Virenque C Haemodynamic changes during retroperitoneoscopic adrenalectomy for phaeochromocytoma.
SO - Br J Anaesth 2001 May;86(5):731-3
AD - Department of Anaesthesiology, Rangueil Hospital, Toulouse University Hospitals, France.
Surgical removal of phaeochromocytoma may be accompanied by acute cardiovascular changes. We report the haemodynamic changes in seven patients with retroperitoneal laparoscopic adrenalectomy for phaeochromocytoma. Transient hypertension (systolic pressure (SBP) > 160 mm Hg) was observed in all patients during manipulation of the tumour, in two patients during pneumoretroperitoneum insufflation, and in one patient during intubation. Small doses of nicardipine were sufficient to control these episodes of hypertension. Transient hypotension (SBP < 100 mm Hg) was observed in two patients during exsufflation and in one patient during repositioning to the lateral position. Our observations suggest that this approach provides relative haemodynamic stability, especially during pneumoretroperitoneum insufflation.
UI - 11574094
AU - Baughan J; de Gara C; Morrish D
TI - A rare association between acromegaly and pheochromocytoma.
SO - Am J Surg 2001 Aug;182(2):185-7
AD - Department of Surgery, Division of General Surgery, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada.
The occurrence of multiple endocrine tumors is rare; however, they may be found with hereditary diseases such as multiple endocrine neoplasia (MEN). The endocrine tumors involved with these diseases are well documented. We present a case of a patient with a pheochromocytoma and a growth hormone (GH) secreting pituitary adenoma. This association is not described with any of the known MEN syndromes. The association may be a cross-over MEN syndrome or a secondarily induced GH-secreting pituitary adenoma from a pheochromocytoma producing growth hormone releasing hormone (GHRH) instead of catecholamines.
UI - 11584528
AU - Fuessl HS
TI - [Secondary hypertension, 4: Pheochromocytoma as etiology of hypertension]
SO - MMW Fortschr Med 2001 Sep 6;143(35-36):39-40
AD - Ltd. Arzt Innere Abt., Bezirkskrankenhaus Haar, Ringstr. 33a, D-85540 Haar. HFuessl@compuserve.com
UI - 11606344
AU - Poopalalingam R; Chin EY
TI - Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate.
SO - Can J Anaesth 2001 Oct;48(9):876-80
AD - Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore. firstname.lastname@example.org
PURPOSE: To describe the rapid perioperative optimization and control of blood pressure in a young patient who presented with pheochromocytoma. He was non-compliant with phenoxybenzamine but insisted on early surgery. He was scheduled for laparoscopic resection of the tumour. CLINICAL FEATURES: This 32-yr-old man presented with uncontrolled hypertension for a few years for which he was treated with nifedipine. He subsequently defaulted follow-up. The patient presented again approximately three months from the day of surgery and was diagnosed to have a pheochromocytoma. The endocrinologist prescribed phenoxybenzamine and propanolol in addition to the nifedipine but the patient stopped taking both drugs six weeks prior to surgery due to their side effects. The patient was admitted the evening before surgery to the intensive care unit for rapid control of his blood pressure. Blood pressure was optimized with an infusion of labetolol and volume expansion titrated under central venous catheter and intraarterial blood pressure guidance throughout the night. On the morning of surgery, a magnesium sulfate infusion was started. The laparoscopic surgery proceeded uneventfully and the patient was hemodynamically stable. There were two transient periods of hypotension after induction and at removal of tumour respectively which were corrected with a brief adrenaline infusion. No adverse outcome was noted. CONCLUSION: This case highlights the possibility of a more rapid perioperative control of pheochromocytoma using high doses of labetolol and a magnesium sulfate infusion to achieve stable intraoperative hemodynamics during laparoscopic resection of pheochromocytoma.
UI - 11684959
AU - Salmenkivi K; Haglund C; Arola J; Heikkila P
TI - Increased expression of tenascin in pheochromocytomas correlates with malignancy.
SO - Am J Surg Pathol 2001 Nov;25(11):1419-23
AD - Department of Pathology, Haartman Institute, University of Helsinki and HUCH Laboratory Diagnostics, Helsinki University Central Hospital, Helsinki, Finland. email@example.com
Tenascin is a significant extracellular matrix glycoprotein, which is upregulated in various neoplasias and pathologic processes. Pheochromocytomas are rare tumors of the sympathoadrenal system, whose malignancy is almost impossible to predict. There are no histologic or chemical markers available that would define the malignant behavior of these tumors, except the discovery of metastases. In our search for new markers, we investigated the immunohistochemical expression of tenascin in a large number of pheochromocytomas and paragangliomas. Seven tumors were metastasized and were thus considered malignant. Normal adrenal medulla was tenascin negative. A striking difference was seen between malignant and benign pheochromocytomas. All malignant pheochromocytomas expressed stromal tenascin strongly or moderately, whereas most benign pheochromocytomas (28 of 37, 70%) showed no or only weak immunopositivity. The staining was strong or moderate also in 13 of 28 (46%) of the tumors that showed histologically suspicious features, here called borderline tumors. Paragangliomas showed a more heterogeneous staining pattern, and no significant difference was found between benign and malignant paragangliomas. To our knowledge, this is the first study to demonstrate the expression of tenascin in pheochromocytomas and particularly the enhanced expression in malignant pheochromocytomas. We therefore suggest that tenascin may be associated with the malignant transformation and metastasis of pheochromocytomas. It is also a potential marker predicting more aggressive behavior in pheochromocytomas.
UI - 11693208
AU - O'Halloran T; McGreal G; McDermott E; O'Higgins N
TI - 47 years of phaeochromocytomas.
SO - Ir Med J 2001 Jul-Aug;94(7):200-3
AD - Department of Surgery, St. Vincent's Hospital, Dublin.
Thirty three patients with phaeochromocytomas had surgery in St. Vincent's Hospital between 1950 and 1997. 32 patients had hypertension, 32 had palpitations and 30 had excessive sweating. All patients had at least one of these cardinal symptoms. Diagnostic tests changed over this period. In the early cases the phentolamine test was used, later diagnosis was confirmed by measurement of urinary VMA and catecholamines. IVP, CT, ultrasound or MIBG scanning were used to locate the tumours. Before 1967, 3 of 17 patients died peri-operatively, 2 of these from strokes and one from pulmonary embolism. Since then, all patients have survived surgery. Four of the women had phaeochromocytomas diagnosed during pregnancy. Two of the 33 patients had tumours that were malignant, the remainder being benign. One patient has died from metastatic disease. This series illustrates the changing trends in the surgical management of phaeochromocytomas.
UI - 11709729
AU - Astuti D; Agathanggelou A; Honorio S; Dallol A; Martinsson T; Kogner P;
TI - Cummins C; Neumann HP; Voutilainen R; Dahia P; Eng C; Maher ER; Latif F RASSF1A promoter region CpG island hypermethylation in phaeochromocytomas and neuroblastoma tumours.
SO - Oncogene 2001 Nov 8;20(51):7573-7
AD - Section of Medical and Molecular Genetics, Department of Paediatrics and Child Health, University of Birmingham, The Medical School, Edgbaston, Birmingham, B15 2TT, UK.
Deletions of chromosome 3p are frequent in many types of neoplasia including neural crest tumours such as neuroblastoma (NB) and phaeochromocytoma. Recently we isolated several candidate tumour suppressor genes (TSGs) from a 120 kb critical interval at 3p21.3 defined by overlapping homozygous deletions in lung and breast tumour lines. Although mutation analysis of candidate TSGs in lung and breast cancers revealed only rare mutations, expression of one of the genes (RASSF1A) was absent in the majority of lung tumour cell lines analysed. Subsequently methylation of a CpG island in the promoter region of RASSF1A was demonstrated in a majority of small cell lung carcinomas and to a lesser extent in non-small cell lung carcinomas. To investigate the role of 3p TSGs in neural crest tumours, we (a) analysed phaeochromocytomas for 3p allele loss (n=41) and RASSF1A methylation (n=23) and (b) investigated 67 neuroblastomas for RASSF1A inactivation. 46% of phaeochromocytomas showed 3p allele loss (38.5% at 3p21.3). RASSF1A promoter region hypermethylation was found in 22% (5/23) of sporadic phaeochromocytomas and in 55% (37/67) of neuroblastomas analysed but RASSF1A mutations were not identified. In two neuroblastoma cell lines, methylation of RASSF1A correlated with loss of RASSF1A expression and RASSF1A expression was restored after treatment with the demethylating agent 5-azacytidine. As frequent methylation of the CASP8 gene has also been reported in neuroblastoma, we investigated whether RASSF1A and CASP8 methylation were independent or related events. CASP8 methylation was detected in 56% of neuroblastomas with RASSF1A methylation and 17% without RASSF1A methylation (P=0.0031). These results indicate that (a) RASSF1A inactivation by hypermethylation is a frequent event in neural crest tumorigenesis, particularly neuroblastoma, and that RASSF1A is a candidate 3p21.3 neuroblastoma TSG and (b) a subset of neuroblastomas may be characterized by a CpG island methylator phenotype.
UI - 11701743
AU - Salmenkivi K; Haglund C; Ristimaki A; Arola J; Heikkila P
TI - Increased expression of cyclooxygenase-2 in malignant pheochromocytomas.
SO - J Clin Endocrinol Metab 2001 Nov;86(11):5615-9
AD - Department of Pathology, Haartman Institute, University of Helsinki and HUCH Laboratory Diagnostics, Helsinki University Central Hospital, FIN-00014 Helsinki, Finland. firstname.lastname@example.org
Pheochromocytomas are rare tumors of the adrenal medulla or the paraganglion system. There are no histological or chemical markers available that define the malignant behavior of these tumors; so far only the discovery of metastases reveals malignancy. Cyclooxygenase (Cox) is the key enzyme in conversion of arachidonic acid to PGs, and two isoforms, Cox-1 and Cox-2, have been identified. Cox-2 has been associated with carcinogenesis, and it is overexpressed in many human malignancies. We have now investigated the expression of Cox-2 in normal adrenal gland, in 92 primary pheochromocytomas and in six metastases using immunohistochemistry and Northern blot and Western blot analyses. Cox-2 protein was expressed in the adrenal cortex, whereas the medulla was negative as detected by immunohistochemistry. Interestingly, all malignant pheochromocytomas (n = 8), regardless of the primary location of the tumor, showed moderate or strong Cox-2 immunoreactivity, whereas 75% of the benign adrenal tumors (n = 36) showed no or only weak immunopositivity. The staining was negative or weak in 79% of the adrenal tumors that showed histologically suspicious features (n = 24), but had not metastasized. Most of the pheochromocytoma samples studied also expressed low levels of Cox-2 mRNA. Our data show that normal adrenal medulla does not express Cox-2 immunohistochemically. However, strong Cox-2 protein expression was found in malignant pheochromocytomas, whereas most benign tumors expressed Cox-2 only weakly. To our knowledge, this is the first report on Cox-2 expression in pheochromocytomas and enhanced expression in malignant pheochromocytomas. These findings suggest that negative or weak Cox-2 expression in pheochromocytomas favors benign diagnosis.
UI - 11714015
AU - Sotunmbi PT; Shittu OB; Windokun A; Eyelade OA
TI - Combined general and epidural anaesthesia for excision of phaeochromocytoma--a unique and safe technique.
SO - Afr J Med Med Sci 2000 Sep-Dec;29(3-4):319-22
AD - Department of Anesthesia, University College Hospital, Ibadan, Nigeria.
Surgical excision of phaeochromocytoma is usually associated with elevation of arterial blood pressure above 200 mmHg for some time irrespective of the use or not of preoperative alpha-adrenergic blockade. Attempts at controlling the elevated blood pressure usually involve the use of many drugs through induction, maintenance, termination and post operative period. We recently used a combined general and epidural anaesthesia for excision of a huge phaeochromocytoma in a 24 yr old Nigerian lady with a satisfactory outcome. The combined technique seemed to have modified the anaesthetic course considerably, resulting in the use of fewer drugs and a steady haemodynamic state which is very unusual in anaesthesising patients with phaeochromocytoma (see haemodynamic record Illustration II). Post-operative analgesia was provided with morphine given through the epidural catheter.
UI - 11715546
AU - Sun Z; Wang Y; Li Z
TI - [Recurrent pheochromocytoma]
SO - Zhonghua Wai Ke Za Zhi 1998 Jan;36(1):59-60
AD - Department of Urology, First Affiliated Hospital, China Medical University, Shenyang 110001.
OBJECTIVE: To improve the diagnosis of recurrent pheochromocytoma. METHODS: To study 11 cases of recurrent pheochromocytoma treated from 1970 to 1996. RESULTS: The recurrence was due to the metastasis of malignant tumor and the multifocal occurrence of benign one. Extraadrenal pheochromocytomas tended to occur at several sites or metastasize. The metastatic places usually no show pheochromatic tissues, and the recurrent benign tumors were liable to grow at extraadrenal regions. The nature of recurrent tumors should be judged according to variant factors. CONCLUSION: The recurrent pheochromocytomas are not malignant in nature, but they have considerable malignant tendency and should undergo intensive survelliance and regular examinations especially for the primary or recurrent extraadrenal pheochromocytomas.
UI - 11506307
AU - Moritani H; Sakamoto M; Yoshida Y; Nasu H; Nemoto R; Nakamura I
TI - Pheochromocytoma of the urinary bladder revealed with cerebral hemorrhage.
SO - Intern Med 2001 Jul;40(7):638-42
AD - Department of Cardiology, Tottori Prefectural Central Hospital, Tottori-shi.
The case was a 51-year-old man, who has been undergoing treatment with oral medication for hypertension for three years. The patient was admitted to the author's clinic for hemorrhage in the left putamen. He was diagnosed as having primary pheochromocytoma of the bladder from such symptoms as paroxysmal blood pressure elevation after urination, mild increase in catecholamine levels before and after urination, and from the results of 131I-MIBG scintigraphy, and cystoscopy, and underwent excision of the bladder tumor. Upon endocrinological examination, only mild increases in catecholamine levels were found. Therefore, constant monitoring of blood pressure and 131I-MIBG scintigraphy were useful for a definitive diagnose.
UI - 11759939
AU - Sharma N; Kumari S; Jain S; Varma S
TI - Pheochromocytoma: a 10-year experience in a tertiary care North Indian hospital.
SO - Indian Heart J 2001 Jul-Aug;53(4):481-5
AD - Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh. email@example.com
BACKGROUND: The study was carried out to highlight the clinical and biochemical profile of patients with pheochromocytoma in a tertiary care center of North India. METHODS AND RESULTS: Thirty consecutive cases of pheochromocytoma admitted over a period of 10 years to our Institute were analyzed. The chief clinical complaints of these 30 patients (17 males and 13 females, mean age 24+/-7 years) were palpitation (80%), headache (77%), sweating (60%), breathlessness (67%) and flushing (56%). The clinical triad of headache, flushing and sweating occurred in 26.7% of cases. On clinical examination, 97% of the patients were hypertensive and 16.6% presented with malignant hypertension. Laboratory measurements showed that the levels of 24-hour urinary vanillylmandelic acid were elevated in 80% of cases. Levels of plasma adrenaline and noradrenaline were raised in 78% and 79% of cases, respectively. Anatomical localization of the tumor on computerized tomographic scan showed the presence of an adrenal tumor in 80% and extra-adrenal tumor in 20%. Surgical removal of the tumor could be carried out in 28 cases following control of the blood pressure with antihypertensive drugs including alpha and beta adrenoreceptor blockers. CONCLUSIONS: Pheochromocytoma should be suspected in all young hypertensive persons. The appropriate therapy for this tumor is surgical removal preceded by adequate blood pressure control including the use of alpha and beta adrenoreceptor antagonists.
UI - 11715896
AU - Ather MH; Altaf S; Memon A
TI - A critical step in the operative management of non-functioning asymptomatic incidentaloma.
SO - J Pak Med Assoc 2001 Aug;51(8):299-300
AD - Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi.
UI - 11767369
AU - Arnault-Ouary G; Chatal JF; Charbonnel B
TI - [Pheochromocytoma]
SO - Rev Prat 1998 Apr 1;48(7):744-8
AD - Clinique d'endocrinologie Maladies metaboliques et nutrition, Hotel-Dieu 44093 Nantes.
Pheochromocytoma is a tumor secreting catecholamines and is most often a sporadic and benign adrenal tumor. But in some cases the tumor is extra-adrenal (10%), malignant (10%) or familial (10%) and in this last case frequently bilateral. The clinical expression of pheochromocytoma is typically hypertension, with paroxysms including headache, excessive sweating, palpitations, but various clinical presentations can be observed. The biological diagnosis is represented by the measurement of urinary catecholamines. The most sensitive and specific test is the measurement of urinary metanephrines or of plasma methoxyamines. The tumor localization is generally easy using CT scan and (or) NMR imaging, associated with MIBG scintigraphy. The treatment is surgical after medical management.
UI - 11767320
AU - Kato T; Takase H; Waguri Y; Ikeda K; Takahashi M
TI - Epidural anaesthesia for insertion of a femoral neck prosthesis in a patient with phaeochromocytoma.
SO - Eur J Anaesthesiol 1993 Nov;10(6):441-4
AD - Department of Anesthesiology, Toyokawa City Hospital, 1-19 Komei-cho, Toyokawa, Aichi 442, Japan.
A hemiarthroplasty for femoral neck fracture was successfully performed under combined epidural anaesthesia and light general anaesthesia before phaeochromocytoma removal. Pre-operative therapy was managed with doxazosin, enalapril and diltiazem. Peri-operative management facilitated maintenance of stable haemodynamic conditions. Post-operative pain management was provided with continuous 1% lignocaine infusion via an epidural catheter. The phaeochromocytoma was finally removed uneventfully 7 weeks after hemiarthroplasty.
UI - 1973879
AU - Grosse H; Schroder D; Schober O; Hausen B; Dralle H
TI - [The importance of high-dose alpha-receptor blockade for blood volume and hemodynamics in pheochromocytoma]
SO - Anaesthesist 1990 Jun;39(6):313-8
AD - Zentrum Anaesthesiologie, Abteilung I, Medizinische Hochschule Hannover.
This prospective clinical study evaluates the possible beneficial effects of increased phenoxybenzamine dosage in the preoperative treatment of patients with pheochromocytoma. For this purpose total blood volume (TBV) prior to and after treatment with phenoxybenzamine and hemodynamic changes during surgery were determined in two groups of patients: group I (n = 12) received a mean dosage of 140 mg, group II (n = 12) 270 mg/day. The mean TBV in group I showed no changes after treatment with phenoxybenzamine, while the TBV in group II increased by 5.6 ml/kg body weight, corresponding to an increase in plasma volume (PV) of 10.2%. These changes were not significant, however. The intraoperative vasodilator requirement for the treatment of catecholamine induced hypertension during tumor manipulation was significantly less for group II: total nitroprusside administration averaged 8.7 mg in group I and 0.8 mg in group II (P less than 0.0005). Patients in group I received a total of 2.6 mg nitroglycerin compared with only 0.5 mg for patients in group II (P less than 0.005). In conclusion, preoperative treatment of patients with pheochromocytoma with increased dosages of phenoxybenzamine is beneficial to intraoperative management by decreasing hemodynamic instability due to tumor manipulation and following resection. This treatment was effective for preventing complications such as excessive tachycardia, cardiac arrhythmias, hypertensive crises, or left ventricular failure.
UI - 11640997
AU - Ishii C; lnoue K; Negishi K; Tane N; Awata T; Katayama S
TI - Diabetic ketoacidosis in a case of pheochromocytoma.
SO - Diabetes Res Clin Pract 2001 Nov;54(2):137-42
AD - The Fourth Department of Medicine, Saitama Medical School, 38 Morohongo, Moroyama-Machi, Saitama 350-0495, Iruma-Gun, Japan. firstname.lastname@example.org
A 31-year-old woman was admitted to our hospital because of diabetic ketoacidosis (DKA). Ultrasound sonography revealed the existence of the left adrenal tumor and endocrinological examinations established a diagnosis of pheochromocytoma. She had been healthy and there was no evidence for gestational diabetes in her personal history. Characteristic features were not found in her tumor size and the catecholamine levels as compared with typical cases of pheochromocytoma. An overwhelming secretion of catecholamine might suppress insulin secretion, as evidenced by the improvement after the resection of the tumor. However, a significant insulin resistance continued after tumor resection. Obesity and the heterozygosity of beta3-adrenergic receptor gene (Try64Arg) might play a role in insulin resistance, which resulted in DKA at least in part. Literature survey revealed four cases of DKA in the patients with pheochromocytoma including ours, three of which were Japanese. Pancreatic capacity to secrete insulin has been reported to be less than Caucasians, which might be another reason for DKA. Thus, we speculate that both suppressed insulin secretion and insulin resistance deteriorated by obesity or other factor(s) such as abnormality in beta3 adrenergic receptor probably depress beta-cell function resulting in abnormal metabolic imbalance such as DKA.
UI - 11572905
AU - Kuzmanovska D; Sahpazova E; Kocova M; Damjanovski G; Popov Z
TI - Phaeochromocytoma associated with reversible renal artery stenosis.
SO - Nephrol Dial Transplant 2001 Oct;16(10):2092-4
AD - Department of Nephrology, University Pediatric Clinic, Skopje, R. Macedonia.
UI - 11572908
AU - Kolhe N; Stoves J; Richardson D; Davison AM; Gilbey S
TI - Hypertension due to phaeochromocytoma--an unusual cause of multiorgan failure.
SO - Nephrol Dial Transplant 2001 Oct;16(10):2100-4
AD - Department of Renal Medicine, St James's University Hospital, Leeds, UK.
UI - 11742341
AU - Li ML; Fitzgerald PA; Price DC; Norton JA
TI - Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy.
SO - Surgery 2001 Dec;130(6):1072-7
AD - University of California, San Francisco, Calif., USA.
BACKGROUND: Laparoscopic adrenalectomy is now regarded as the procedure of choice for treatment of small or benign adrenal tumors, including pheochromocytoma. However, long-term outcomes have not been critically assessed. We report here 3 cases of pheochromocytomatosis recurring 3 to 4 years after laparoscopic adrenalectomy. We postulate laparoscopic-induced seeding of tumor as the mechanism of recurrence. METHODS: We retrospectively reviewed the cases of 3 patients with documented biochemical and radiolabeled metaiodobenzylguanidine evidence of recurrent pheochromocytoma after prior presumed curative laparoscopic adrenalectomy. RESULTS: Original pheochromocytomas were 5.5 to 6.5 cm in diameter. At the time of laparoscopic adrenalectomy, tumors were not believed to be malignant, based on clinical or histopathologic data. However, on 3- to 4-year follow-up, each patient developed symptoms, elevated urinary catecholamine levels, and metaiodobenzylguanidine imaging consistent with recurrence. At reoperation, multiple small tumor nodules were found in the adrenal bed near the site of the initial laparoscopic resection. The original operative notes suggested some possible method of local seeding: tumor fragmentation and spillage or excessive tumor manipulation. CONCLUSIONS: Pheochromocytoma recurrence may occur as a result of local spillage of tumor during laparoscopic adrenalectomy. The relative risk of recurrence between open and laparoscopic resection needs to be assessed. Long-term follow-up will continue to be important, regardless of operative approach.
UI - 11510758
AU - Tomita N; Moriguchi A; Yamasaki K; Taniyama Y; Kotani N; Hashiya N;
TI - Yoshida M; Yao M; Higaki J; Ogihara T A family with von Hippel-Lindau disease revealed by pheochromocytoma.
SO - Hypertens Res 2001 Jul;24(4):445-50
AD - Department of Geriatric Medicine, Osaka University Medical School, Suita, Japan. email@example.com
Von Hippel-Lindau (VHL) disease is an inherited neoplastic disease characterized by a predisposition to develop retinal angiomas, central nervous system hemangioblastomas, renal cell carcinomas, pancreatic cysts and pheochromocytomas. Recently, we encountered three members of the same family who each had both VHL disease and pheochromocytoma. As in all three patients we suspected pheochromocytoma, the diagnosis of VHL disease should be considered. The possible presence of VHL disease was initially investigated in all three patients based on the presence of pheochromocytoma. A mutational analysis of the VHL gene revealed the presence of a missense mutation, consisting of a G to A transversion, at nucleotide 713 in all three patients. This germline point mutation in the VHL gene is often detected in type 2 VHL disease with pheochromocytoma. Genetic analysis seems to be useful for early detection of VHL disease, even when the formal criteria for diagnosis of this disease are lacking.
UI - 11701346
AU - Shapiro B; Gross MD; Shulkin B
TI - Radioisotope diagnosis and therapy of malignant pheochromocytoma.
SO - Trends Endocrinol Metab 2001 Dec;12(10):469-75
AD - The Nuclear Medicine Service, Dept of Veterans Affairs, Ann Arbor, MI 48105, USA. firstname.lastname@example.org
The availability of radiopharmaceuticals to depict primary malignant pheochromocytoma and its metastases has markedly changed the approach to these unusual cancers. Whole body screening afforded by scintigraphy allows remote tumor involvement to be identified and provides staging information necessary to guide subsequent therapy. The avid accumulation by malignant pheochromocytoma of some radiopharmaceuticals used for scanning has shown promise in therapeutic trials. In this paper, we discuss radiopharmaceuticals presently employed in malignant pheochromocytoma for both diagnostic and therapeutic uses and potential future compounds that may find their way into clinical practice in the approach to these and other related neoplasms.
UI - 11816951
AU - McCurry T; Bybee DE; Skaggs G; Richardson JD
TI - Pheochromocytoma.
SO - J Ky Med Assoc 2001 Nov;99(11):487-92
AD - Department of Surgery, University of Louisville, Louisville, Ky. 40292, USA.
Causes of hypertension that are amenable to surgical treatment constitute a very small but potentially important segment of the hypertensive population. These causes (which constitute frequently asked questions for medical students) include coarctation of the aorta, aldosterone and corticosteroid-producing tumors of the adrenal glands, lesions producing decreased renal blood flow, and pheochromocytoma. This latter tumor is quite uncommon, with a frequency of roughly one per million, but often produces dramatic hypertensive episodes. Due to its rarity, physicians in practice may not consider the diagnosis and appropriately evaluate the patient. We present the case histories of three patients with pheochromocytoma who demonstrate important features of this disease. Diagnostic evaluation and principles of treatment will be discussed.
UI - 11789820
AU - Kumar P; Walcot N; Carpenter R; Uppal R
TI - Concomitant off-pump myocardial revascularization and pheochromocytoma resection.
SO - Ann Thorac Surg 2001 Dec;72(6):2139-41
AD - Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, England.
Surgical management of patients with coexisting ischemic heart disease and pheochromocytoma remains challenging. We present one such case in which hybrid myocardial revascularization (angioplasty with stenting and off-pump coronary artery bypass grafting) and resection of pheochromocytoma were undertaken. Unusual features included simultaneous coronary artery surgery and tumor resection and, in particular, coronary artery surgery being performed without cardiopulmonary bypass.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.