scholarly journals Pheochromocytoma Rupture Associated With Systemic Anticoagulation: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A150-A150
Author(s):  
WingYee Wan ◽  
Sky Denniston Graybill
Keyword(s):  
Adrenal Mass ◽  
Surgical Oncology ◽  
Pulmonary Emboli ◽  
Intravenous Heparin ◽  
Adrenal Pheochromocytoma ◽  
Alpha Blockade ◽  
Systemic Anticoagulation ◽  
Plasma Free Metanephrines ◽  
Piecemeal Resection

Abstract Background: Pheochromocytoma rupture is a rare endocrine emergency. There have been approximately 85 documented cases, and the mortality rate for patients who require emergent surgery is as high as 34% (1). Clinical Case: A 30-year-old man with no past medical history presented to the Emergency Department with abdominal pain and vomiting. He was hypertensive, tachycardic, and hypoxic. CT Chest Angiogram revealed bilateral pulmonary emboli and a 6.5 x 5.5 x 6.4 cm left heterogenous adrenal mass. His plasma free metanephrines were elevated to 31,173 pg/mL (n<62 pg/mL) with normetanephrines >50,000 pg/mL (n<145 pg/mL). His pulmonary emboli was treated with continuous intravenous heparin, and he was also treated with intravenous fluids and phentolamine due to concern for pheochromocytoma. Within hours, he became hypotensive, and his hemoglobin downtrended from 16.4 g/L to 7.3 g/L (n 14–18 g/L). Repeat CT showed that the adrenal mass had ruptured, enlarging to 15.4 x 9.7 x 10.0 cm. He was taken for an emergent laparotomy with piecemeal resection of the mass; surgical pathology confirmed a pheochromocytoma. Fortunately, the patient recovered well after surgery. After 6 months, his plasma free metanephrines normalized to 15 pg/mL with normetanephrines of 80 pg/mL. His DOTATATE scan was negative for malignancy and his genetic testing was negative. Conclusion: The patient’s systemic anticoagulation and critical illness likely increased his risk for pheochromocytoma rupture. Standard preoperative pheochromocytoma management, to include aggressive fluid resuscitation and alpha blockade, is important in reducing risk of morbidity and mortality. Biochemical follow up is required, as there is a 16% risk of recurrence. Reference: (1) Kobayashi T, Iwai A, Takahashi R, Ide Y, Nishizawa K, Mitsumori K. Spontaneous rupture of adrenal pheochromocytoma: Review and analysis of prognostic factors. Journal of Surgical Oncology. 2005;90(1).

scholarly journals A Case Report of a Giant Pheochromocytoma

2020 ◽  
Vol 2 (1) ◽  
pp. 25-30
Author(s):  
Dian Anindita Lubis ◽  
Agnes Stephanie Harahap ◽  
Em Yunir
Keyword(s):  
Adrenal Mass ◽  
Adrenal Glands ◽  
Adrenal Tumor ◽  
Clinical Biochemistry ◽  
Signs And Symptoms ◽  
Abdominal Ultrasonography ◽  
Dyspeptic Symptoms ◽  
S 100 ◽  
Adrenal Pheochromocytoma

Pheochromocytoma is a rare catecholamine secreting tumor that are usually arise from adrenal medulla and produces signs and symptoms of excessive catecholamine secretion from tumor. A 32 years old female presented to the hospital, with dyspeptic symptoms. She had fluctuative hypertension, palpitation and sweating. Abdominal ultrasonography showed a right adrenal mass, and computed tomography of the adrenal glands confirmed a right adrenal mass. However, clinical biochemistry tests specific for pheochromocytoma was not performed. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, S-100 protein, and inhibin. Following the surgery, the patient did well and showed full recovery at follow-up after 1 month. 

scholarly journals The challenge of improving the diagnostic yield from metanephrine testing in suspected phaeochromocytoma and paraganglioma

2018 ◽  
Vol 55 (6) ◽  
pp. 679-684 ◽  
Author(s):  
Intan Samsudin ◽  
Michael M Page ◽  
Kirsten Hoad ◽  
Paul Chubb ◽  
Melissa Gillett ◽  
...  
Keyword(s):  
Information System ◽  
Adrenal Mass ◽  
Diagnostic Yield ◽  
Laboratory Information System ◽  
Biochemical Tests ◽  
Laboratory Report ◽  
Repeat Test ◽  
Plasma Free Metanephrines

Background Plasma-free metanephrines (PFM) or urinary fractionated metanephrines (UFM) are the preferred biochemical tests for the diagnosis of phaeochromocytoma and paraganglioma (PPGL). Borderline increased results should be followed up to either exclude or confirm diagnosis. Methods We extracted all PFM and UFM results reported by our laboratory over a six-month period from the laboratory information system. We categorized patients with borderline increased results according to whether follow-up testing had been performed as suggested in the initial laboratory report. Questionnaires were then sent to all requesting doctors and medical notes reviewed where available. Results Two hundred and four patients with borderline increased PFM or UFM were identified. Sixty-five (38.5%) of 169 patients with borderline increased PFM had a repeat test out of which 36 were normal and 29 did not normalize. Of 35 patients with borderline increased UFM, 17 (48.6%) had subsequent PFM measurement, out of which 15 were normal. Questionnaires were returned to 106 (52%) patients. Of these, the most frequent indication for testing was hypertension ( n = 50); 15 patients had an incidental adrenal mass and two of these patients were diagnosed with a phaeochromocytoma. Conclusion Only 38% of patients with borderline increased PFM had a repeat PFM measurement. This was not significantly higher when compared with the 28% in a previous audit that we reported in 2010 ( P = 0.10). Forty-nine per cent of patients with a borderline increased UFM had a repeat UFM or PFM measurement. There remains a substantial possibility of missed detection of PPGL.

1524: High Energy Tumt and Adjuvant Alpha Blockade Significantly Improves Symptoms in Men with Cathegory IIIB (CPPS) Prostatitis. A Prospective Non-Randomized with 5 Years Follow Up

2006 ◽  
Vol 175 (4S) ◽  
pp. 491-492
Author(s):  
Sybille Mariharl ◽  
Christian Seitz ◽  
Bob Djavan ◽  
Matthias Walderl ◽  
Michael Dobrovits ◽  
...  
Keyword(s):  
High Energy ◽  
Alpha Blockade

scholarly journals Adrenal Cortex-Sparing Surgery for Bilateral Multiple Pheochromocytomas in a Patient with Von Hippel-Lindau Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Tarık Esen ◽  
Ömer Acar ◽  
Ahmet Tefekli ◽  
Ahmet Musaoğlu ◽  
İzzet Rozanes ◽  
...  
Keyword(s):  
Adrenal Cortex ◽  
Adrenocortical Function ◽  
Renal Masses ◽  
Von Hippel Lindau ◽  
Pancreatic Masses ◽  
Adrenal Pheochromocytoma ◽  
Von Hippel Lindau Disease ◽  
Vhl Disease

Pheochromocytomas can be a part of familial neoplastic syndromes, in which case they tend to be multiple and involve both adrenal glands. Therefore, sparing adrenocortical function represents a major concern while dealing with these hereditary lesions. Herein, we describe the clinical characteristics and the management strategy of a patient with von Hippel-Lindau (VHL) disease who had multiple, bilateral pheochromocytomas as well as bilateral renal masses, pancreatic masses, and a paracaval mass. Only a portion of the left adrenal gland has remained in situ after two consecutive open surgeries and a percutaneous radiofrequency ablation which have been performed to treat the various components of this syndrome. No adrenal or extra-adrenal pheochromocytoma recurrences have been detected during a follow-up period of more than 2 years. Pancreatic and adrenal functions were normal throughout the postoperative period and never necessitated any replacement therapy. Adrenal cortex-sparing surgery is a valid option for VHL disease patients who present with synchronous bilateral adrenal pheochromocytomas.

Acute hypertensive crisis due to newly diagnosed pheochromocytoma in the ninth decade of life: an unusual presentation

2021 ◽  
Vol 14 (2) ◽  
pp. e239433
Author(s):  
Carmen Cartwright ◽  
Peter Ucciferro ◽  
Catherine Anastasopoulou
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Adrenal Mass ◽  
Hypertensive Crisis ◽  
Surgical Removal ◽  
Newly Diagnosed ◽  
Alpha Blockade ◽  
Artery Disease ◽  
Biochemical Testing ◽  
High Index Of Suspicion

The patient is an 85-year-old man with multiple comorbidities, including hypertension and coronary artery disease with recent myocardial infarction who underwent cardiac catheterisation. During the procedure, the patient developed profound hypertensive crisis with flash pulmonary oedema, requiring significant intervention for blood pressure (BP) control. His crisis was also marked by wide excursions in his BP. The patient was found to have a large left adrenal mass measuring 9.4×8.7×8.1 cm, with biochemical testing confirming the suspicion of pheochromocytoma. Alpha-blockade was started prior to availability of lab results due to high index of suspicion. Surgical removal, the mainstay of treatment, has yet to transpire as he has no family, and due to his underlying dementia, he was not felt to have capacity for decision-making at the time of diagnosis. The case elucidates the vast presentations of this tumour, the means of diagnosis and the difficulties of treatment.

scholarly journals A comparison of surgical pulmonary embolectomy and catheter-directed lysis for life-threatening pulmonary emboli

2019 ◽  
Vol 30 (3) ◽  
pp. 388-393 ◽  
Author(s):  
Amalia A Winters ◽  
Michael J McDaniel ◽  
Jose N Binongo ◽  
Rena C Moon ◽  
Wissam A Jaber ◽  
...  
Keyword(s):  
Regression Models ◽  
Pulmonary Emboli ◽  
Short Term ◽  
Pulmonary Embolectomy ◽  
Treatment Groups ◽  
Catheter Directed Thrombolysis ◽  
Risk Patients ◽  
Life Threatening ◽  
Rv Function

Abstract OBJECTIVES Patients with life-threatening pulmonary emboli (PE) have traditionally been treated with anticoagulation alone, yet emerging data suggest that more aggressive therapy may improve short-term outcomes. The purpose of this study was to compare postoperative outcomes between catheter-directed thrombolysis (CDL) and surgical pulmonary embolectomy (SPE) in the treatment of life-threatening PE. METHODS A retrospective single-centre observational study was conducted for patients who underwent SPE or CDL at a single US academic centre. Preprocedural and postprocedural echocardiographic data were collected. Unadjusted regression models were constructed to assess the significance of the between-group postoperative differences. RESULTS A total of 126 patients suffered a life-threatening PE during the study period [60 SPE (47.6%), 66 CDL 52.4%]. Ten (24.4%) SPE patients and 10 (15.2%) CDL patients had massive PEs marked by preprocedural hypotension. Six (10.0%) SPE patients and 4 (6.0%) CDL patients suffered a preprocedure cardiac arrest (P = 0.41). In-hospital mortality rate was 3.3% (2) for SPE, and 3.0% (2) for CDL (P = 0.99). SPE patients were more likely to require prolonged ventilation (15.0% vs 1.5%, P = 0.01). No significant differences were found in other major complications. At baseline echocardiography, 76.9% of SPE patients and 56.9% of CDL patients had moderate or severe right ventricular (RV) dysfunction. Both treatment groups showed marked and durable improvement in echocardiographic markers of RV function from baseline at midterm follow-up. CONCLUSIONS Both SPE and CDL can be applied to well-selected high-risk patients with low rates of morbidity and mortality. Further research is necessary to delineate which patients would benefit most from either SPE or CDL following a life-threatening PE.

scholarly journals Ischemic Hand Complications From Intra-Arterial Injection of Sublingual Buprenorphine/Naloxone Among Patients With Opioid Dependency

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. 507-511 ◽  
Author(s):  
Ryan M. Wilson ◽  
Shady Elmaraghi ◽  
Brian D. Rinker
Keyword(s):  
Treatment Algorithm ◽  
Hand Surgery ◽  
Tissue Loss ◽  
Opioid Dependency ◽  
Sublingual Buprenorphine ◽  
Review Period ◽  
Intravenous Heparin ◽  
Oral Agents ◽  
Clinical Records

Background: Sublingual buprenorphine/naloxone, a common treatment for opioid dependence, is frequently abused by intravenous injection. Inadvertent intra-arterial injection of buprenorphine/naloxone can produce acute ischemic insult to the hand due to gelatin embolism. Our purpose was to review a series of these patients in order to describe the clinical entity, review the outcomes, and propose a rational treatment algorithm. Methods: Clinical records of all patients evaluated by the hand surgery team between 2011 and 2015 for ischemia of the hand after buprenorphine/naloxone injection were reviewed. Treatment, complications, and amount of tissue loss were recorded. Patients presenting within 48 hours of the injection were treated with intravenous heparin for 5 days, followed by oral aspirin and clopidogrel for 30 days. Those presenting after 48 hours were treated with aspirin and clopidogrel only. Results: Ten patients presented during the review period. Average follow-up time was 13 weeks. Eight had ischemia of the radial side of the hand, 1 of the ulnar side, and 1 had bilateral ischemia. Three patients were treated with intravenous heparin and 5 with oral agents. Two presented with dry gangrene and did not receive anticoagulation. All patients experienced tissue loss. There was no difference in outcome regardless of treatment. Conclusions: With the increasing use of sublingual buprenorphine/naloxone in opioid dependency, ischemic hand injuries will be seen with greater frequency. Whereas outcomes did not vary with treatment modality in this series, further study is needed to determine the most effective treatment of these injuries.

Adrenal pheochromocytoma with involvement of aorta and left renal artery: salvaged with adrenalectomy and nephrectomy

2021 ◽  
Vol 14 (9) ◽  
pp. e244297
Author(s):  
Shekhar Sathaye ◽  
Kalpesh Mahesh Parmar ◽  
Santosh Kumar ◽  
Pulkit Rastogi
Keyword(s):  
Renal Artery ◽  
Renal Involvement ◽  
Renal Tissue ◽  
Preoperative Imaging ◽  
Beta Blockade ◽  
Left Renal Artery ◽  
Rare Entity ◽  
Rare Presentation ◽  
Adrenal Pheochromocytoma

Large adrenal pheochromocytomas encasing the renal artery are a rare entity. The management of such challenging cases is surgical resection. The involvement of renal tissue and renal artery may necessitate meticulous dissection and concomitant nephrectomy. Here, we present a case of 41-year-old man diagnosed with left adrenal pheochromocytoma with complete encasement of left renal artery and partial encasement of aorta. Open left adrenalectomy and nephrectomy was performed after adequate preoperative optimisation. The patient is doing well at 6-month follow-up. Large adrenal pheochromocytoma with renal involvement is a rare presentation and requires optimal preoperative imaging, adequate preoperative alpha and beta blockade and meticulous surgical technique.

Case 6.11

2014 ◽  
pp. 304-305
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Adrenal Gland ◽  
Signal Intensity ◽  
Adrenal Mass ◽  
Large Mass ◽  
Female Infant ◽  
Hepatic Parenchyma ◽  
The Right ◽  
T2 Weighted Images

1-month-old female infant with a renal or adrenal mass Axial fat-suppressed FSE T2-weighted images (Figure 6.11.1) reveal a large mass originating from the right adrenal gland with heterogeneously increased signal intensity. Extensive small hyperintense metastases essentially replace the visualized hepatic parenchyma. Axial fat-suppressed FSE images from the 6-week follow-up examination (...

scholarly journals SUN-939 Case Report: Malignant Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jose Viana Lima ◽  
Rosa Paula Mello Biscolla ◽  
Maria Izabel Chiamolera ◽  
Marco Antonio Conde Oliveira
Keyword(s):  
Weight Loss ◽  
Case Report ◽  
Chromogranin A ◽  
Scoring Systems ◽  
Lytic Lesion ◽  
Sdhb Mutation ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Abdominal Lesion

Abstract Introduction: The concept of malignancy for pheochromocytoma is complex and the best definition is the presence of metastases, according to WHO. Anatomopathological scoring systems are not effective in predicting metastases. Malignancy should be considered when tumors larger than 8cm (> 80g), paragangliomas (especially retroperitoneal), dopamine / methoxythyramine increase, Ki67> 6% and SDHB mutation. At 5 years, survival ranges from 50-69%. Metastases may appear 20-40 years after initial treatment of pheochromocytoma. We describe a case that metastasis was identified 33 years after pheochromocytoma excision Case report: A 57-year-old female patient with a postoperative history of 33 years of right adrenal pheochromocytoma was discharged from the endocrinologist after 10 years of follow-up. At diagnosis 33 years ago, she had symptoms of hypertension with paroxysms and weight loss that disappeared after tumor removal. 2 years investigating weight loss with general practitioner without another celebratory. On physical examination, orthostatic hypotension was highlighted. Plasma methanephrine 0.8 nmol / L (VR <0.5) and plasma normetanephrine 1.8 nmol / L (VR <0.9), chromogranin A 5.7 nmol / L (VR <3 nmol / L) and clonidine test with 36.6% suppression of metanephrines, suggesting tumor recurrence. MRI localized recurrence of the adrenals and MIBG scintigraphy with I131 that showed, respectively, in the topography next to the paracaval and retroportal right diaphragmatic crura, isointense T1 and slightly hyperintense T2 at 1.8 cm and radiopharmaceutical hypercaptation in right adrenal topography. Genetic panel by NGS did not identify germline mutation in 22 pheochromocytoma-related genes. FDG PETCT was consistent with MRI and MIBG images. Gallium PETCT68 DOTATOC detected the lesions already described, in addition to a lytic lesion in the left femoral intertrochanteric medulla. Anatomopathological approached abdominal lesion confirming pheochromocytoma metastasis in lymph node conglomerate. Currently has a negative methanephrine plasma, however chromogranin A 142 ng / mL (VR <93), and was chosen by the observant approach. Conclusion: The case of the patient illustrates that pheochromocytoma should be followed indefinitely, as metastases may appear many years later and may present different aggressiveness potentials.

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