scholarly journals Undiagnosed pheochromocytoma presenting as a pancreatic tumor: A case report

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Malgorzata Emilia Legocka ◽  
Sadegh Toutounchi ◽  
Ryszard Pogorzelski ◽  
Ewa Krajewska ◽  
Krzysztof Celejewski ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Surgical Complications ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Preoperative Treatment ◽  
Tumor Type ◽  
Abdominal Incision ◽  
Alpha Blockers ◽  
Severe Hypotension ◽  
Life Threatening

AbstractPheochromocytoma is a rare catecholamine-producing tumor of the adrenal gland. Patients with known pheochromocytoma undergoing surgery require preoperative treatment with alpha-blockers to reduce the risk of intraoperative complications related to catecholamine release. If undiagnosed, pheochromocytoma can lead to life-threatening surgical complications. We report the case of a patient with a suspected solid pseudopapillary neoplasm in the pancreatic tail, for whom pancreatoduodenectomy was scheduled. However, shortly after abdominal incision, hypertensive crisis developed and was followed by severe hypotension requiring intravenous vasopressors, which prompted discontinuation of the operation. Further diagnostic evaluation revealed marked elevations in urinary excretion of methylated catecholamines and suggested that the tumor was in fact a pheochromocytoma extending from the left adrenal gland. After preoperative treatment with doxazosin, the patient underwent lateral transperitoneal laparoscopic adrenalectomy, with no major complications and an uneventful postoperative course. The pathological report confirmed a diagnosis of pheochromocytoma. Due to the potential for life-threatening surgical complications in patients with pheochromocytoma not treated preoperatively with alpha-blockers, this tumor type should be included in the differential diagnosis of abdominal tumors of unknown origin.

scholarly journals Asymptomatic Presacral Paraganglioma: Management of an Unpredictable Intraoperative Finding

2020 ◽  
Vol 06 (02) ◽  
pp. e131-e134
Author(s):  
Athina A. Samara ◽  
Alexandros Diamantis ◽  
Dimitrios Symeonidis ◽  
Athanasios Anagnostou ◽  
Andreas Marios Diamantis ◽  
...  
Keyword(s):  
Neural Crest ◽  
Neuroendocrine Tumors ◽  
Rare Case ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Clinical Suspicion ◽  
Anatomical Location ◽  
Presacral Mass ◽  
Life Threatening ◽  
High Level

AbstractParagangliomas are rare neuroendocrine tumors originating from the embryological neural crest. We report a rare case of a patient with an asymptomatic presacral mass (incidentaloma) who experienced an unpredictable intraoperative hypertensive crisis after manipulation of the tumor. Presacral neoplasms pose a diagnostic and therapeutic challenge due to their obscure anatomical location and the difficulty in performing an R0 excision. Furthermore, the management of asymptomatic paragangliomas requires a high level of clinical suspicion and expertise due to potential life-threatening intraoperative complications.

scholarly journals Asymptomatic mediastinal extra-adrenal paraganglioma as a cause of sudden death: a case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 564-567
Author(s):  
Qiancheng Xu ◽  
Yingya Cao ◽  
Hongzhen Yin ◽  
Rongrong Wu ◽  
Tao Yu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Respiratory Failure ◽  
Pressure Drop ◽  
Thoracic Cavity ◽  
Severe Hypotension ◽  
Life Threatening ◽  
History Of ◽  
Posterior Mediastinal ◽  
Extra Adrenal Paraganglioma

AbstractA 23-year-old female patient was referred for treatment of a posterior mediastinal tumour. There was no history of hypertension or headache and no other complaints. The patient’s blood pressure increased to 210/125 mmHg after surgically manipulating the tumour, subsequently reversing to severe hypotension (25/15 mmHg) immediately after the tumour was removed. The life-threatening and irreversible blood pressure drop was difficult to treat with fluid and vasopressors, and the patient ultimately died of cardio-respiratory failure. Asymptomatic paraganglioma can be non-functional but can also be fatal. For any lump in the thoracic cavity, paraganglioma should be ruled out.

Life-Threatening Complication During Percutaneous Ablation of Adrenal Gland Metastasis: Takotsubo Syndrome

2009 ◽  
Vol 33 (3) ◽  
pp. 646-649 ◽  
Author(s):  
Georgia Tsoumakidou ◽  
Xavier Buy ◽  
Pierre Zickler ◽  
Michel Zupan ◽  
Marie-Pierre Douchet ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Percutaneous Ablation ◽  
Takotsubo Syndrome ◽  
Adrenal Gland Metastasis ◽  
Life Threatening ◽  
Life Threatening Complication

scholarly journals Hypertensive crisis caused by electrocauterization of the adrenal gland during hepatectomy

BMC Surgery ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
A Ram Doo ◽  
Ji-Seon Son ◽  
Young-Jin Han ◽  
Hee Chul Yu ◽  
Seonghoon Ko
Keyword(s):  
Adrenal Gland ◽  
Hypertensive Crisis

Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients

2006 ◽  
Vol 4 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Shinya Okuda ◽  
Akira Miyauchi ◽  
Takenori Oda ◽  
Takamitsu Haku ◽  
Tomio Yamamoto ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Complications ◽  
Interbody Fusion ◽  
Intraoperative Complications ◽  
Posterior Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Neurological Complications ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

Object Previous studies of surgical complications associated with posterior lumbar interbody fusion (PLIF) are of limited value due to intrastudy variation in instrumentation and fusion techniques. The purpose of the present study was to examine rates of intraoperative and postoperative complications of PLIF using a large number of cases with uniform instrumentation and a uniform fusion technique. Methods The authors reviewed the hospital records of 251 patients who underwent PLIF for degenerative lumbar disorders between 1996 and 2002 and who could be followed for at least 2 years. Intraoperative, early postoperative, and late postoperative complications were investigated. Intraoperative complications occurred in 26 patients: dural tearing in 19 patients and pedicle screw malposition in seven patients. Intraoperative complications did not affect the postoperative clinical results. Early postoperative complications occurred in 19 patients: brain infarction occurred in one, infection in one, and neurological complications in 17. Of the 17 patients with neurological complications, nine showed severe motor loss such as foot drop; the remaining eight patients showed slight motor loss or radicular pain alone, and their symptoms improved within 6 weeks. Late postoperative complications occurred in 17 patients: hardware failure in three, nonunion in three, and adjacent-segment degeneration in 11. Postoperative progression of symptomatic adjacentsegment degeneration was defined as a condition that required additional surgery to treat neurological deterioration. Conclusions The most serious complications of PLIF were postoperative severe neurological deficits and adjacent-segment degeneration. Prevention and management of such complications are necessary to attain good long-term clinical results.

Hypersensitivity Anaphylactoid Reaction to Pefloxacin in a Patient with Aids

1996 ◽  
Vol 30 (6) ◽  
pp. 612-614 ◽  
Author(s):  
Mogbil A Al-Hedaithy ◽  
Ayman M Noreddin ◽  
Rafaela Mena ◽  
Mare-Claude Vanier
Keyword(s):  
Broad Spectrum ◽  
Mycobacterium Avium Complex ◽  
Anaphylactoid Reaction ◽  
Antimicrobial Agents ◽  
New Drugs ◽  
Pertinent Literature ◽  
Case Summary ◽  
Severe Hypotension ◽  
Life Threatening ◽  
Anaphylactoid Reactions

Objective To report a life-threatening anaphylactoid reaction to oral pefloxacin in a patient with AIDS and to review the pertinent literature. Case Summary A 32-year-old woman with AIDS developed an anaphylactoid reaction following a second exposure to oral pefloxacin. This reaction was characterized by severe hypotension, dizziness, itching, and fever. Discussion Fluoroquinolones are broad-spectrum antimicrobial agents. They are used frequently in patients with AIDS for numerous indications, including treatment of Mycobacterium avium complex. Pefloxacin, a broad-spectrum fluoroquinolone, was introduced in France in 1985. Since then, many patients with AIDS have been treated with this drug. Several cases of anaphylactoid reactions to ciprofloxacin have been documented in patients with HIV infection. To our knowledge, this is the first reported case of an anaphylactoid reaction to pefloxacin in a patient with AIDS. Conclusions There is a need for continued vigilance in the reporting of adverse drug reactions in patients with AIDS, especially with new drugs. Also, care must be taken in introducing drugs, including fluoroquinolones, to this patient population.

PACAP release from the canine adrenal gland in vivo: its functional role in severe hypotension

2003 ◽  
Vol 284 (2) ◽  
pp. R588-R597 ◽  
Author(s):  
Stéphane Lamouche ◽  
Nobuharu Yamaguchi
Keyword(s):  
Adrenal Gland ◽  
Nerve Stimulation ◽  
Splanchnic Nerve ◽  
Dependent Manner ◽  
Severe Hypotension ◽  
Pituitary Adenylate Cyclase ◽  
Catecholamine Response ◽  
Splanchnic Nerve Stimulation

This study was to investigate if endogenous pituitary adenylate cyclase-activating polypeptide (PACAP) can be released during direct splanchnic nerve stimulation in vivo and to determine whether PACAP in the adrenal gland can modulate the medullary response to sympathoadrenal reflex. The output of adrenal catecholamine and PACAP-38-like immunoreactivity (PACAP-38-ir) increased in a frequency-dependent manner after direct splanchnic nerve stimulation (0.2–20 Hz). Both responses were highly reproducible, and PACAP-38-ir output closely correlated with catecholamine output. Sodium nitroprusside (SNP; 0.1 mg/kg iv bolus) caused a severe hypotension resulting in marked increases in catecholamine secretion. In the presence of local PACAP-27 (125 ng), the maximum catecholamine response to SNP was significantly potentiated in a synergistic manner compared with that obtained in the group receiving SNP or PACAP-27 alone. The study indicates that endogenous PACAP-38 can be released particularly when the sympathoadrenal system is highly activated and that the local exogenous PACAP-27 enhanced the reflex-induced catecholamine release, suggesting collectively a facilitating role of PACAP as neuromodulator in the sympathoadrenal function in vivo.

Selective versus non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma – systematic review and meta-analysis

2021 ◽  
Author(s):  
Karolina Zawadzka ◽  
Krzysztof Więckowski ◽  
Piotr Małczak ◽  
Michał Wysocki ◽  
Piotr Major ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Preoperative Treatment ◽  
Adrenergic Blockade ◽  
Alpha Blockers ◽  
Alpha Blockade ◽  
Sympathetic Paraganglioma

Objective: Alpha-adrenergic blockade is currently the first choice of preoperative treatment in patients with functional pheochromocytoma and sympathetic paraganglioma. Nevertheless, there is no consensus whether selective or non-selective alpha-blockade is superior for preventing both perioperative hemodynamic instability and complications. Design: Our study aimed to compare selective and non-selective alpha-blockade through a systematic review with meta-analysis. Methods: MEDLINE, Embase, Web of Science and Cochrane Library were searched for eligible studies. Randomized and observational studies comparing selective and non-selective alpha-blockade in pheochromocytoma and sympathetic paraganglioma surgery in adults were included. Data on perioperative hemodynamic parameters and postoperative outcomes were extracted. Results: Eleven studies with 1,344 patients were enrolled. Patients receiving selective alpha-blockade had higher maximum intraoperative systolic blood pressure (WMD 12.14 mm Hg, 95% CI 6.06-18.21, p<0.0001) compared to those treated with non-selective alpha-blockade. Additionally, in the group pretreated with selective alpha-blockers, intraoperative vasodilators were used more frequently (OR 2.46, 95% CI 1.44-4.20, p=0.001). Patients treated with selective alpha-blockers had lower minimum intraoperative systolic blood pressure (WMD -2.03 mmHg, 95% CI -4.06 to -0.01, p=0.05) and shorter length of hospital stay (WMD -0.58 days, 95% CI -1.12 to -0.04, p=0.04). Operative time, overall morbidity and mortality did not differ between the groups. Conclusions: This meta-analysis shows non-selective alpha-blockade was more effective in preventing intraoperative blood pressure fluctuations while maintaining comparable risk of both intraoperative and postoperative hypotension and overall morbidity.

scholarly journals Life-threatening Development of Cardiac Tamponade in the Span of 24 Hours

2019 ◽  
Vol 3 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Patrick Kishi ◽  
Thaer Ahmad ◽  
Kenneth Dodd
Keyword(s):  
Cardiac Output ◽  
Cardiac Tamponade ◽  
Effective Treatment ◽  
Medical Emergency ◽  
Emergency Physicians ◽  
Pericardial Space ◽  
Severe Hypotension ◽  
Life Threatening

Cardiac tamponade is a medical emergency that requires immediate treatment. Caused by the development of fluid in the pericardial space, it can result in a severe decrease in cardiac output. When encountering patients with severe hypotension and tachycardia, emergency physicians must always consider the diagnosis of tamponade to facilitate prompt and effective treatment and stabilization. We report our experience with a patient who developed life-threatening cardiac tamponade within a span of less than 24 hours.

scholarly journals Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sari Naddaf ◽  
Scott Ehrenberg ◽  
Rony Hakim ◽  
Muhamad Mahamid ◽  
Yoav Turgeman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Elective Surgery ◽  
Hypertensive Crisis ◽  
Rare Event ◽  
Pulseless Electrical Activity ◽  
Functional Changes ◽  
Wide Range ◽  
Life Threatening ◽  
Failure Life

Abstract Background Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery. Case presentation A healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved. Conclusion In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment.

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