scholarly journals A Tale of Two Cities: Do They Have the Same Destination: Asymptomatic Pheochromocytomas: Biochemically Functioning vs Non Functioning

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A106-A106
Author(s):  
Gabriela Zuniga Paniagua ◽  
Samarth Vimarni ◽  
Dominique Broutin ◽  
Suzanne Martinez ◽  
Sowmya K Suryanarayanan
Keyword(s):  
Morbidity And Mortality ◽  
High Morbidity ◽  
Vanillylmandelic Acid ◽  
Preoperative Preparation ◽  
Endocrine Society ◽  
Ct Guided ◽  
Asymptomatic Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
Alpha Blockade ◽  
Urine Metanephrines

Abstract Background: Pheochromocytomas (PHEOs) are enterochromaffin tumors arising from the adrenal gland. Their diagnosis and preoperative preparation is crucial due to high morbidity and mortality rates with unrecognized, undiagnosed PHEOs. Case 1: 62-year-old male with a medical history of HCC, noted to have right adrenal adenoma measuring 1.7 x 1.6 cm. Denied any symptoms and normotensive on exam. A PET scan done showed a hypermetabolic right adrenal nodule concerning for malignancy. Serum metanephrines were 45 pg/ml (nl <57 pg/ml) and total plasma metanephrines were 172 pg/ml (nl <205 pg/ml). A CT guided biopsy was consistent with a PHEO. Other labs included: 24 hour urine metanephrines: 155 mcg (nl 90–315), total metanephrines: 520 (nl 224–832) and vanillylmandelic acid was 3.6 (nl <6.0). 24-hour urine epinephrine: 10 mcg (nl 2–24), norepinephrine:57 mcg (nl 15–100) and dopamine: 421 (normal 52–480). Case 2: 55 year old male with UTI and flank discomfort, noted to have incidental 8cm Right adrenal mass noted concerning for malignancy. Also denied any symptoms and normotensive. Plasma fractionated metanephrines 938 (ref <206), metanephrine 279,Normetanephrine 659(ref <148), 24 hr urine metanephrines=1176mcg/24 hr (90–315), Normetanephrines 1487 (122–676), 24 hr urine total metanephrines 2663 (224–832). He is refusing α and β blockade due to normotension in preparation for surgery. Discussion: It is important to suspect, confirm, localize, treat, and PHEOs for several reasons. Most of these tumors hypersecrete catecholamines, and if untreated, cardiovascular morbidity and mortality are high. Another reason to encourage case detection is that, for familial disease, detection of a tumor in the proband may result in earlier diagnosis and treatment in other family members. Alpha-blockade is usually used prior to resection of Pheochromocytomas. However, the data available in the literature regarding alpha blockade for “truly asymptomatic” functioning or non functioning Pheochromocytomas is scarce. However what is unique to our cases is that they both are normotensive and asymptomatic and refusing preoperative preparation. Conclusion: Asymptomatic PHEO are becoming more common presentation given Pheochromocytomas are rare. Are the genetics and biochemical nature any different than classic pheos? Are we supposed to manage them the same way? Would we rethink current guidelines for managing normotensive or nonfunctioning pheochromocytomas pre operatively? We also would like guidelines on how to prepare such truly asymptomatic patients prior to surgery. We refer to Endocrine Society guidelines for management of such tumors.

scholarly journals A Simplified Approach to Reducing Cardiovascular Risk

2019 ◽  
Vol 104 (12) ◽  
pp. 6033-6039 ◽  
Author(s):  
David S Schade ◽  
R Philip Eaton
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Treatment Guidelines ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
The United States ◽  
Morbidity And Mortality ◽  
Simplified Approach ◽  
Asymptomatic Patients ◽  
Cardiovascular Morbidity And Mortality

Abstract Context Cardiovascular disease remains the number one cause of morbidity and mortality in the United States, despite major advances in our understanding of its pathogenesis and prevention. One reason for this continued epidemic is the poor adherence to treatment guidelines by caregivers and the lack of understanding by patients relative to its reversibility with treatment. Current guidelines are complex and often contradictory; there are at least 21 organizations publishing guidelines. Objective This article proposes a simplified approach that is based on the low-density lipoprotein (LDL) hypothesis stating that the lower the LDL cholesterol (LDL-C), the less the cardiovascular disease. This goal focuses on obtaining a plasma LDL-C <50 mg/dL. Design A positive coronary artery calcium scan in conjunction with an intermediate online cardiovascular risk score will identify individuals with substantial cardiovascular disease risk. With lifestyle improvements (including a low cholesterol diet) and low-dose hypolipemic generic oral medications, this LDL-C concentration is readily achievable in the majority of asymptomatic patients at risk for atherosclerosis. Conclusion Controlling the cardiovascular epidemic will require participation of both the patient and the physician caregiver. By simplifying the therapeutic regimen, patient compliance will increase, and an important reduction in cardiovascular morbidity and mortality will follow.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

2020 ◽  
Vol 99 (5) ◽  
pp. 200-206
Keyword(s):  
Oesophageal Cancer ◽  
Surgical Procedure ◽  
Anastomotic Dehiscence ◽  
Gastric Conduit ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

scholarly journals Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Che-Fang Ho ◽  
Yuan-Yun Tam ◽  
Chia-Chen Wu
Keyword(s):  
Rare Complication ◽  
Bed Rest ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Adequate Treatment ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Intravenous Antibiotics ◽  
Computed Tomography Scans ◽  
Intravenous Hydration ◽  
Prompt Diagnosis

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

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