Undiagnosed Phaeochromocytoma Research Articles

Anaesthetic management of a patient posted for excision of retroperitoneal cyst with undiagnosed phaeochromocytoma.

Anaesthetic management of a patient posted for excision of retroperitoneal cyst with undiagnosed phaeochromocytoma.

Pheochromocytoma Induced Cardiomyopathy: A Rare Cause of Sudden Circulatory Collapse Precipitated by Intravenous Metoclopramide

Phaeochromocytoma are rare endocrine tumours with a diverse range of presenting symptoms including cardiogenic shock. We describe a case of acute catecholamine cardiomyopathy with rapid circulatory collapse following a dose of intravenous metoclopramide in a patient with undiagnosed phaeochromocytoma.

A dangerous master of disguise - An undiagnosed phaeochromocytoma presenting with pulmonary haemorrhage

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Undiagnosed Phaeochromocytoma in Cardiac Surgery

Unsuspected phaeochromocytoma diagnosed during cardiac cases presents as a life-threatening situation. Unfortunately, phaeochromocytoma is not usually diagnosed until after the events has occurred. Based on a handful of cases, mortality can range from 25%–95%. Intraoperatively, patients become profoundly hypertensive requiring input from anaesthetics to control blood pressure, which adds more time to bypass and overall operation time. This case series presents two cases of undiagnosed phaeochromocytoma during coronary artery bypass graft, one of whom passed away. Given the limited studies, this will contribute greatly so that others will learn when to suspect and how to treat if diagnosis is made.

Phaeochromocytoma Crisis: Two Cases of Undiagnosed Phaeochromocytoma Presenting after Elective Nonrelated Surgical Procedures

Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case.

Découverte fortuite d’un phéochromocytome en peropératoire : le cauchemar de l’anesthésiste

We report the case of a patient who presented hypertension paroxysmal with acute pulmonary oedema followed by cardiocirculatory arrest during gynaecological surgery for resection of latero-aortic lymph nodes suspected to be cervical cancer metastases. This intervention, originally oncologic, has discovered ectopic phaeochromocytoma a posteriori. The management of perioperative serious adverse events revealing the undiagnosed phaeochromocytoma is discussed.

Traumatic haemorrhage of occult phaeochromocytoma in a patient with septic shock

Phaeochromocytoma can have a variety of presentations; however, traumatic hemorrhage into a phaeochromocytoma is a very rare presentation. Diagnosing and managing a critically ill, septic patient with a Phaeochromocytoma can be very challenging. We report a case of 53 years old man with a previously undiagnosed Phaeochromocytoma, who presented initially with bowel perforation following an assault. Following a laparotomy for bowel resection and anastomosis, whilst on the intensive care unit, he developed paroxysmal severe hypertension overlying septic shock. Phaeochromocytoma was confirmed using a computed tomography scan and urinary assay of metanephrine and catecholamines. We managed the haemodynamic instability using labetalol and noradrenaline infusions. As his septic state improved he was convention therapy and following control of his symptoms over the next few weeks, he underwent an uncomplicated right sided adrenalectomy. He made a full recovery.

Reply to Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Reply to Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Traumatic haemorrhage into an occult phaeochromocytoma: presentation and management in a patient with septic shock

Phaeochromocytomas can have a variety of presentations; however, traumatic haemorrhage into a phaeochromocytoma is a rare presentation. Diagnosing and managing a critically ill, septic patient with a phaeochromocytoma can be very challenging. We report a case of a 57-year-old man, with a previously undiagnosed phaeochromocytoma, who presented initially with bowel perforation following an assault. Following a laparotomy for bowel resection and anastomosis, whilst on the intensive care unit, he developed paroxysmal severe hypertension overlying septic shock. Phaeochromocytoma was confirmed using a computed tomography scan and urinary assay of metanephrines and catecholamines. We managed the haemodynamic instability using labetalol and noradrenaline infusions. As his septic state improved he was started on conventional therapy and following control of his symptoms over the next few weeks, he underwent an uncomplicated right sided adrenalectomy. He made a full recovery.

Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Reply EDITOR: We thank Dr Fassam for his interest in our study and his comments [1]. We agree with him that the use of beta blockers is not a favourable option and has limited indications during arrhythmias in case of phaeochromocytoma. In our case, during surgery both beta-blocker drugs were selected to control aggravated hypertension of the patient who had regulated hypertension before surgery. The diagnosis of phaeochromocytoma was not suspected at that time. So we agree with Fassam that beta blockers, unfortunately, might have contributed to the severity of hypertensive attacks. The other recommended agent phentolamine, a short-acting alpha blocker, could not be used due to unavailability in our institution during this case. Magnesium sulphate is routinely used to control arrhythmias and hypertension in patients undergoing cardiovascular surgery and in the Caesarean section of preeclamptic patients or ICU patients. However, magnesium sulphate is not the first drug of choice to control hypertension in other surgical procedures. First a vasodilatory drug treatment including nitroglycerine, nitroprusside, calcium-channel-blockers or beta blockers is started and subsequently other adjuvant drugs are added according to the features of the cardiovascular status of the hypertensive patients and even in some patients with phaeochromocytoma as reported by Fassam in reference 4 [2]. It appears that questions concerning the appropriate management of patients with phaeochromocytoma during surgery are increasing. In reference 4 sited by Fassam, all patients were given isoflurane. However, isoflurane was inadequate to attenuate their arterial hypertension. Hence it is not superior to propofol in this aspect and may even have a negative effect to prevent intracranial pressure increase in severe hypertensive crises. In our case, single bolus following infusion of propofol dramatically decreased arterial pressure. The effect of propofol on blood pressure seems to be an additive effect to vasodilator treatment used previously. We agree about the comments on magnesium sulphate. If we consider the effects of propofol and magnesium sulphate on the cardiovascular system, a further choice might be the combination of propofol and magnesium sulphate to manage hypertensive crisis of patients having phaeochromocytoma, perhaps without alpha blocker treatment. A better attenuation of cardiovascular responses can be obtained because of their potentiation of each other. I. Alper E. Taydas S. Ulukaya T. Balcioglu U. Aydin M. Kilic 1Department of Anaesthesiology and Reanimation Ege University School of Medicine Bornova Izmir, Turkey

Undiagnosed phaeochromocytoma during mitral valve repair

Undiagnosed phaeochromocytoma during mitral valve repair

Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Additive effect of propofol for attenuation of hypertension in a patient with undiagnosed phaeochromocytoma

Undiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term

We report an unusual case of phaeochromocytoma in pregnancy. The patient presented with severe hypertension, visual disturbances, proteinuria, glycosuria and pulmonary oedema at 38 weeks' gestation. The initial diagnosis was severe preeclampsia, but rapid deterioration of the fetus necessitated an emergency caesarean section under general anaesthesia, following which the maternal condition deteriorated rapidly. Differential diagnoses included pulmonary embolus, cardiomyopathy, amniotic fluid embolus and ischaemic/embolic cerebrovascular accident. Despite aggressive maximal treatment, mother and baby died 36 h later. Post mortem examination of the mother revealed a 5.5-cm tumour of the right adrenal gland confirmed histologically as a phaeochromocytoma. We examine the diagnostic dilemmas of this case and consider the treatment and management options when faced with a critically ill mother and the need to deliver her fetus by emergency caesarean section. We also question the clinical priorities during management of a sudden deterioration in both maternal and fetal health.

Betahistine

Betahistine is a structural analogue of histamine that is prescribed for the treatment of vestibular disorders such as Ménière's disease and the symptomatic treatment of vertigo. It is estimated from sales information that >130 million patients have been exposed to the drug since its registration in 1968. In this review we analyse the safety profile of betahistine based on data obtained during >35 years of worldwide postmarketing surveillance. Until 31 December 2005, 554 adverse drug reaction (ADR) reports with 994 individual signs and symptoms were received by the marketing authorisation holder from worldwide sources and were reviewed and evaluated. Signs and symptoms of cutaneous hypersensitivity reactions during betahistine therapy were the most frequently reported complaints. They consisted of usually mild and self-limiting rash, pruritus and urticaria, and all symptoms were reversible after drug discontinuation. Betahistine was reported to be involved in one anaphylactoid reaction and one case of Stevens-Johnson syndrome. Anaphylactic reactions with fatal outcome were not reported. The reports that describe gastrointestinal complaints mostly concern nausea and vomiting or unspecific abdominal pain. These were typically non-serious complaints. Hepatobiliary involvement was reported 25 times, including increases in alkaline phosphatase, gamma-glutamyltransferase, and alanine and aspartate aminotransferase levels. None of the patients concerned developed severe liver failure or died. ADRs related to the nervous system predominantly reveal heterogeneous events that are not suggestive of a specific adverse reaction profile for betahistine. A clinical intolerance to betahistine that gave rise to asthma or bronchospasm was only reported in eight ADRs. A total of three cases of neoplasm have been reported. One case concerned a male patient of unknown age who experienced weight loss, insomnia, impatience and irritability soon after the start of betahistine therapy. An undiagnosed phaeochromocytoma was suspected. The remaining two cases were assessed as being unrelated to betahistine by the reporter. Finally, four deaths have been reported during the course of postmarketing surveillance for betahistine. The reporter assessed the causal relationship to betahistine in two as unrelated, in one as unlikely and the other as unassessable. In summary, clinical and postmarketing studies have revealed a good safety profile of betahistine that was confirmed by the safety surveillance data presented.

Myocardial infarction and death after Caesarean section in a woman with protein S deficiency and undiagnosed phaeochromocytoma

Myocardial infarction and death after Caesarean section in a woman with protein S deficiency and undiagnosed phaeochromocytoma