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Pheochromocytoma and anesthesia

Rashmi Ramachandran, Vimi Rewari
Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, (123)I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging...
January 2017: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Shipra Aggarwal, Vandana Talwar, Pooja Virmani, Suniti Kale
Familial pheochromocytomas are commonly associated with multiple endocrine neoplasia type 2 (MEN 2) syndrome. Majority of the patients present with normal clinical and biochemical parameters in the preoperative period, the incidence of hypertension being only 50 %. Even though patients may be clinically asymptomatic, surveillance and proper preoperative evaluation is important, as surgery for associated tumors may precipitate a hypertensive crisis and result in severe complications. A family of 19 members, of which 12 were positive for MEN 2A syndrome, presented to our hospital...
October 2016: Indian Journal of Surgery
Ashwin Subramaniam, Robert Grauer, David Beilby, Ravindranath Tiruvoipati
Myotonic dystrophy (DM), though rare, can significantly complicate anesthesia due to muscular and extra-muscular involvement. When this condition is compounded by a pheochromocytoma, anesthetizing such patients becomes extra challenging. We present a case report of a 61-year-old lady with congenital DM, with the whole gamut of associated features, was diagnosed with a noradrenaline secreting paraganglionoma following investigation of refractory hypertension. We anesthetized her for an open resection of the lesion...
November 2016: Journal of Clinical Anesthesia
Reese W Randle, Courtney J Balentine, Susan C Pitt, David F Schneider, Rebecca S Sippel
BACKGROUND: The optimal preoperative α-blockade strategy is debated for patients undergoing laparoscopic adrenalectomy for pheochromocytomas. We evaluated the impact of selective versus non-selective α-blockade on intraoperative hemodynamics and postoperative outcomes. METHODS: We identified patients having laparoscopic adrenalectomy for pheochromocytomas from 2001 to 2015. As a marker of overall intraoperative hemodynamics, we combined systolic blood pressure (SBP) > 200, SBP < 80, SBP < 80 and >200, pulse > 120, vasopressor infusion, and vasodilator infusion into a single variable...
January 2017: Annals of Surgical Oncology
Eugene A Hessel
PURPOSE: Takotsubo cardiomyopathy (TTCM) is a form of stress cardiomyopathy that may occur in the perioperative period and among the critically ill. Therefore, anesthesiologists should be aware of its diagnosis and treatment. The aim of this narrative review is describe the features of TTCM and its relevance to the practice of anesthesiology. PRINCIPAL FINDINGS: Takotsubo cardiomyopathy occurs in about 2-9/100,000 persons in the general population annually and may occur in up to one in 6,700 cases in the perioperative period...
September 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Radu Mihail Mirica, Octav Ginghina, Gabriela Zugravu, Razvan Iosifescu, Mihai Ionescu, Anca Ichiman, Adrian Rosca, Alexandra Mirica, Nicolae Iordache, Rubin Munteanu
INTRODUCTION: Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, which can derive from either parasympathetic or sympathetic paraganglia and are closely related to pheochromocytomas. CASE REPORT: We present the case of a young male patient of 37 years old, who was admitted for hypertensive crisis and palpitations. His medical history included medically controlled type 2 diabetes mellitus, (diagnosed 10 months ago), Hepatitis A...
March 2016: Chirurgia
Tatsuo Horiuchi, Tomonori Takazawa, Shigeru Saito
We report here a case of rocuronium-induced anaphylactic shock in a 41-year-old woman. She was scheduled for partial hepatectomy due to liver metastasis of a pheochromocytoma. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was difficult, and her blood pressure fell to around 40 mmHg just after induction. Subsequently, her trachea was intubated and adrenaline was injected. However, due to the subsequent persistence of severe hypotension and hypoxia, cardiopulmonary resuscitation was necessary...
March 2016: Masui. the Japanese Journal of Anesthesiology
Keitaro Tachi, Shinji Takahashi, Makoto Tanaka
BACKGROUND: The amount of urinary catecholamine metabolites (metanephrine and normetanephrine) excreted in 24 hours correlates with catecholamine secretion by pheochromocytoma in a day and is considered an indicator of the strength of its hormonal activity. We investigated the existence of a relationship between the landiolol dose and urinary catecholamine metabolites in the perioperative management of patients with pheochromocytoma. METHODS: We retrospectively investigated the medical and anesthesia records of patients treated at University of Tsukuba Hospital between December 2007 and June 2012...
December 2015: Masui. the Japanese Journal of Anesthesiology
Reiye Esayas Mengesha, Reintraut Brumeister Rother
A 13-year-old girl with right adrenal pheochromocytoma pretreated with Nifedipine, underwent surgical removal of the tumor. General anesthesia with Propofol infusion and pethidine analgesia was performed. To control the blood pressure (BP), Nitroglycerine infusions were administered successfully. Following the ligation of the adrenal veins, patient was hypotensive and inotropic support was required. This case report showed that in the absence of alpha blockers and short acting drugs the surgery could be done with a very good follow up and Nitroglycerine as antihypertensive...
July 2015: Ethiopian Medical Journal
Masaki Kohno, Yusuke Nagamine, Takahisa Goto
We experienced a case of undiagnosed extra-adrenal pheochromocytoma in an adult patient with single ventricle circulation after the bidirectional Glenn operation. A 32-year-old woman was scheduled for open abdominal surgery for incidental retroperitoneal tumor. She had undergone the bidirectional Glenn operation for complex congenital heart disease consisting of double outlet right ventricle, ventricular septal defect, and pulmonary artery stenosis. She had not undergone the Fontan operation because of insufficient development of pulmonary circulation...
September 2015: Masui. the Japanese Journal of Anesthesiology
Laurent Brunaud, Phi-Linh Nguyen-Thi, Eric Mirallie, Marco Raffaelli, Menno Vriens, Pierre-Etienne Theveniaud, Myriam Boutami, Brendan M Finnerty, Wessel M C M Vorselaars, Inne Borel Rinkes, Rocco Bellantone, Celestino Lombardi, Thomas Fahey, Rasa Zarnegar, Laurent Bresler
BACKGROUND: Since the 1950s, preoperative medical preparation has been widely applied in patients with pheochromocytoma to improve intraoperative hemodynamic instability and postoperative complications. However, advancements in preoperative imaging, laparoscopic surgical techniques, and anesthesia have considerably improved management in patients with pheochromocytoma. In consequence, there is no validated consensus on current predictive factors for postoperative morbidity. The aim of this study was to determine perioperative factors which are predictive for postoperative morbidity in patients undergoing laparoscopic adrenalectomy for pheochromocytoma...
March 2016: Surgical Endoscopy
Cheryl Wang, Robert Richmond, Enas Eldesouki
Paragangliomas account for 15-20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has a high mortality rate due to hypertension and challenging anesthetic management. The present report is of a case of the successful management of paraganglioma resection with unexpected aortic resection. The patient presented for paraganglioma resection. The blood pressure (BP) was well controlled with α blockade followed by β blockade prior to surgery. The patient was under general anesthesia, with multiple intravenous lines, catheters and an arterial line...
April 2015: Experimental and Therapeutic Medicine
Bryan Donald Laliberte, Emily Goldenberg, Sarah J Reece-Stremtan
Thyroid storm, a severe complication of hyperthyroidism, can be a devastating medical emergency requiring rapid management. Intraoperative thyrotoxicosis, a hypermetabolic syndrome with increased thyroid hormone levels, also presents a challenging scenario. Clinical suspicion is key along with eliminating other potentially catastrophic emergencies such as malignant hyperthermia or pheochromocytoma. In this case report, we describe a 15-year-old male undergoing halo traction placement for displaced dens and C1 fractures...
October 15, 2014: A & A Case Reports
Ayse Belin Ozer, Ismail Demirel, Ozgur Duzgol, Refik Ayten, Omer Lutfi Erhan
An operation was planned for a female patient aged 59 for intra-abdominal mass. The patient was using nebivolol for hypertension. Blood pressure (BP) of the patient was raised to 200/130 mmHg during anesthesia induction. BP was gradually reduced by remifentanil infusion. Following the manipulation of the mass, BP began to increase (225/160 mmHg), thus nitroglycerin and followed nitroprusside infusion was started. Propofol (200 + 200 mg) and furosemide (20 mg) were administered intravenously. BP suddenly dropped (90/60 mmHg) following the removal of the mass, nitroglycerine, and nitroprusside infusions were stopped; remifentanil dose was decreased and fluid was quickly infused...
November 2014: Saudi Journal of Anaesthesia
Manabu Kitano, Nobuyasu Komasawa, Toshiyuki Sawai, Toshiaki Minami
We report successful anesthetic management of a patient with pheochromocytoma using high-dose landiolol hydrochloride. A 55-year-old man was scheduled to undergo resection of giant pheochromocytoma. Epidural anesthesia was not performed due to anticoagulant therapy for lower limb thrombus. Tracheal intubation was performed with the Pentax-AWS Airwayscope. Preoperative screening revealed urine adrenaline 2.567.0 microg x day(-1) urine noradrenaline 1,734.0 microg x day(-1), and a tumor diameter of 96 x 60 mm...
August 2014: Masui. the Japanese Journal of Anesthesiology
Shaozhong Wei, Dongde Wu, Junqiu Yue
Functional malignant pheochromocytoma is a rare tumor. Also, liver metastatic pheochromocytoma is deemed to be incurable because of its poor prognosis. Surgical debulking and removal of primary and metastases tumors, as well as radiosurgical or surgical treatment are recommended for patients. We treated a patient with multiple liver metastasis of functional malignant pheochromocytoma 4 years after the adrenal primary lesion was resected. The liver metastases were successfully removed by surgical resection. During the operation, the blood pressure increased quickly when the tumor was held between the fingers, reached the highest (201/110 mmHg), and then quickly declined to normal when the pressure was relieved...
November 2013: Journal of Cancer Research and Therapeutics
Natalia Andrade, Luis R Rivas, Milan Milovancev, Mary Ann Radlinsky, Karen Cornell, Chad Schmiedt
OBJECTIVE: To describe an intercostal (IC) approach to the right adrenal (RA) gland in dogs. STUDY DESIGN: Cadaveric study and case series. ANIMALS: Dogs with right adrenal (RA) tumors (n = 11) and normal canine cadavers (6). METHODS: Cadavers had an IC (n = 3) or paracostal (3) approach to the RA. The relative spatial position of the RA to the incision was evaluated. Medical records (June 2007-December 2012) of dogs that had an IC approach to the RA were reviewed...
February 2014: Veterinary Surgery: VS
Rossana Cecchi, Paola Frati, Oriana Capri, Luigi Cipolloni
Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37-year-old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra-operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death...
November 2013: Journal of Forensic Sciences
H S Asha, M S Seshadri, Simon Rajaratnam
Phaeochromocytomas may be discovered incidentally when patients present with hypertensive crisis during general anaesthesia. A 49-year-old man underwent thyroidectomy 25 years ago and was diagnosed to have spindle cell carcinoma of the thyroid. He presented with recent onset of hoarseness of voice and was found to have a vocal cord nodule. He developed a hypertensive crisis during surgery. He was subsequently evaluated and found to have bilateral phaeochromocytoma. Further evaluation revealed a RET proto-oncogene mutation at codon 634 consistent with multiple endocrine neoplasia (MEN)-2A...
November 2012: National Medical Journal of India
Rebecca L Johnson, Katherine W Arendt, Carl H Rose, Michelle A O Kinney
Profound hypotension and resistance to conventional vasopressor therapy following administration of spinal anesthesia for Cesarean delivery occurred in a multiparous parturient. Postpartum evaluation for secondary hypertension showed a diagnosis of pheochromocytoma. Pheochromocytoma was mistaken for preeclampsia with significant vasopressor requirement to treat hypotension from spinal anesthesia. If pheochromocytoma is diagnosed during pregnancy and Cesarean delivery is required, spinal anesthesia may not be the optimal choice of anesthesia...
December 2013: Journal of Clinical Anesthesia
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