Abstract
Background: Catecholamine secreting tumors are responsible of 0.5-2% of hypertension in children. Intraoperative instability in these patients during surgical resection can occur. The objective of this mini-review was to describe the perioperative management of pheochromocytomas, paragangliomas, neuroblastomas and catecholamine secreting tumors in children. Methods: Narrative mini-review. Results and Conclusion: Preoperative medical and intraoperative anesthetic management aim to reduce intraoperative instability in catecholamine secreting tumors.
Highlights
In children, pheochromocytomas (PH) constitute 80-85% of catecholamine secreting tumor (CST) originating from the chromaffin cells of the adrenal gland medulla ; whereas paragangliomas (PG) constitute 5-10% of the extra adrenal pheochromocytomas and are originated from the sympathetic and parasympathetic ganglia and are rarely functional and secreting; neuroblastoma (NB) is a neuroendocrine tumor from the adrenal gland or primitive neural crest elements of the sympathetic nervous system [1,2,3]
Symptoms and signs are due to the circulating catecholamines and present as hypertension, tachycardia, cardiac conduction anomalies, headaches, sweating, flushing, nausea, vomiting, dizziness, anxiety, weight loss, visual disturbance, polyuria, polydipsia, dysphagia due to mass effect, hypertrophic and dilated cardiomyopathy, arrhythmias and renal impairement [2,3,4]
Diagnostic tests realized for screening consist of free plasma and 24 hours urinary catecholamine metabolites dosage namely metanephrine and normetanephrine
Summary
Pheochromocytomas (PH) constitute 80-85% of catecholamine secreting tumor (CST) originating from the chromaffin cells of the adrenal gland medulla ; whereas paragangliomas (PG) constitute 5-10% of the extra adrenal pheochromocytomas and are originated from the sympathetic (in the chest, abdomen and pelvis) and parasympathetic ganglia ( in the head and neck) and are rarely functional and secreting; neuroblastoma (NB) is a neuroendocrine tumor from the adrenal gland or primitive neural crest elements of the sympathetic nervous system [1,2,3]. Results and Conclusion: Preoperative medical and intraoperative anesthetic management aim to reduce intraoperative instability in catecholamine secreting tumors. Prior anesthetic consultation several weeks (at least 1 week before surgery for optimal management) is mandatory with complementary laboratory tests namely hemoglobin and platelet levels , blood urea nitrogen to assess for renal impairment, ions , glycemia, cross match (intraoperative hemorrhage is possible), electrocardiogram and echocardiography (to assess for arrhythmias and cardiomyopathy due to chronic exposure to catecholamines) [1,2,3,4].
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