Current Preoperative Preparation of Pheochromocytoma/Paraganglioma Syndrome
نویسندگان
چکیده
Pheochromocytomas and paragangliomas are catecholamine-producing neoplasms that can cause life-threatening hemodynamic instability, particularly intraoperatively, when the tumor is manipulated. Preoperative medical management reduces both preoperative morbidity and mortality. The current review discusses the latest literature on preoperative management. Preoperative strategies include a nonselective alpha-antagonist, selective alpha antagonists, calcium channel blockers, tyrosine hydroxylase inhibitors, and fluid and salt loading. Compared to selective alpha-antagonists, preparation with phenoxybenzamine prior to surgery is associated with superior intraoperative hemodynamic stability, but also more post-operative hypotension, adverse drug effects, and longer treatment period. No studies indicate a difference in clinical outcomes between phenoxybenzamine and selective alpha-antagonists. Calcium channel inhibitors have been shown in multiple studies to have similar hemodynamic stability and outcomes as patients with pre-operative alpha blockades, particularly in patients with smaller tumors. Metyrosine has been shown to attenuate intraoperative hemodynamic stability when used in conjugation with phenoxybenzamine or a selective alpha-antagonist. Magnesium-sulfate does not improve intraoperative hemodynamic instability when used in conjuction with nicardipine. Therefore multiple effective strategies exist to prevent morbidity and mortality associated with resection, however, a lack of preparation is not one of them. Daniel P Goldstein1, Marcia R Voigt1 and Daniel Ruan2* 1Department of Surgery, Wake Forest School of Medicine, 475 Vine Street, Bowman Gray Center for Medical Education, Winston-Salem, NC 27101, USA 2Department of Surgery, Tampa General Hospital, 1 Tampa General Cir, Tampa, FL 33606, USA
منابع مشابه
SDHB-Associated Paraganglioma in a Pediatric Patient and Literature Review on Hereditary Pheochromocytoma-Paraganglioma Syndromes
Pheochromocytoma and paraganglioma are rare in the pediatric population occurring in approximately 1 in 50,000 children. While some cases are sporadic, they have commonly been associated with syndromes such as von Hippel-Lindau, multiple endocrine neoplasia types IIa and IIb, neurofibromatosis type 1, and hereditary pheochromocytoma-paraganglioma syndromes. In children less than 18 years of age...
متن کاملPheochromocytoma in a Twelve-Year-Old Girl with SDHB-Related Hereditary Paraganglioma-Pheochromocytoma Syndrome
A twelve-year-old girl presented with a history of several weeks of worsening headaches accompanied by flushing and diaphoresis. The discovery of markedly elevated blood pressure and tachycardia led the child's pediatrician to consider the diagnosis of a catecholamine-secreting tumor, and an abdominal CT scan confirmed the presence of a pheochromocytoma. The patient was found to have a mutation...
متن کاملCarotid Body Tumour as an Unusual Cardiovascular Pathology: Report of Two Cases
A carotid body tumour (CBT) is a rare form of an extra-adrenal pheochromocytoma. They are commonly diagnosed as asymptomatic neck masses. A careful preoperative evaluation is required to find out the functional and vascular status of these tumours. Herein, we report two cases of carotid body paraganglioma, their evaluation and surgical management.
متن کاملCarotid body tumours: three case reports.
A carotid body tumour is a rare presentation of an extra-adrenal pheochromocytoma. They commonly present with asymptomatic neck masses, and careful preoperative evaluation is required to find out the functional and vascular status of these tumours. We report three cases of carotid body paraganglioma, their evaluation, management and the final outcome.
متن کامل