Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.
Highlights
Pheochromocytomas (PHEOs) are rare catecholamine-secreting neuroendocrine tumors derived from chromaffin cells of the adrenal medulla (80–85%)
Hydralazine (Apresoline) use is very limited in the management of postoperative hypertension following Pheochromocytomas and paragangliomas (PPGLs) resection due to its long duration of action resulting in hypotension and reflex tachycardia [47]
Best knowledge, most of the published articles focus primarily on preoperative and e care of PPGL patients, whereas studies detailing postoperative management are only m individual case reports. It is extremely important for physicians of PPGL patients to nly appropriate preoperative evaluation and treatment and adequate postoperative rticle, we describe the medical approaches to treat these patients after tumor resection r unique, long-standing experience with these patients at the National Institutes of tionally, we present the notable complications physicians should become aware of, se emergencies that require immediate attention by a well-trained and experienced ist working alongside intensivists
Summary
Pheochromocytomas (PHEOs) are rare catecholamine-secreting neuroendocrine tumors derived from chromaffin cells of the adrenal medulla (80–85%). The useon of an appropriate preoperative antihypertensive regimen can be counterproductive should be focused minimizing tumor manipulation by careful handling of tumor tissue, limiting when effects continue after surgical tumor removal, i.e., a rapid decline of catecholamine levels may intra-abdominal pressure, providing adequate anesthesia and maximizing the use of vasoactive lead to hypotension. Since the pioneering work by Gagner et al of the first laparoscopic resection of PHEO in 1992, shown that patients with higher preoperative metanephrines and catecholamines have higher surgical management of PHEO has considerably improved owing to the advancement in pre, intra, postoperative complications including organ ischemia, bowel obstruction, hypoglycemia, etc. Most of the published focus important primarily onfor preoperative only available from individual case reports It isarticles extremely physiciansand of PPGL intraoperative care of PPGL patients, whereas studies detailing postoperative management only patients to provide appropriate preoperative evaluation and treatment butare adequate available from individual case reports.
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