Diagnosis and management of pheochromocytoma

Current Opinion in Oncology

Volumn 9, Issue 1, 1997, Pages 61-67

  Kenady, Daniel E ^a   McGrath, Patrick C ^a   Sloan, David A ^a   Schwartz, Richard W ^a  

^a UNIVERSITY OF KENTUCKY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

(3 IODOBENZYL)GUANIDINE;

ADRENALECTOMY; ARTICLE; BLOOD PRESSURE REGULATION; CATECHOLAMINE RELEASE; COST EFFECTIVENESS ANALYSIS; DIAGNOSTIC TEST; ECHOGRAPHY; HUMAN; PHEOCHROMOCYTOMA; PRIORITY JOURNAL; SCREENING; SURGICAL TECHNIQUE; TREATMENT PLANNING; TUMOR LOCALIZATION;

EID: 0030934818     PISSN: 10408746     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001622-199701000-00010     Document Type: Article

References (21)

1. Foo M, Burton BJ, Ahmed R: Phaeochromocytoma. Br J Hosp Med 1995, 54:318-321. This is a concise well-written review of the incidence, clinical features, diagnosis, and management of pheochromocytoma. Specifically, these authors comment on practical and current methods for diagnosis and treatment.
2. O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA: Multiple endocrine neoplasia type 2B: more than an endocrine disorder. Surgery 1995, 118:936-942. The Mayo Clinic endocrine surgical group reports on 22 patients with MEN IIB with a follow-up of 17 years. Important features mentioned in this paper include a high incidence of bilateral pheochromocytoma. Furthermore, colonic dysfunction, which has previously received little attention, may well be a marker for MEN IIB.
3. Modigliani E, Vasen HM, Raue K, Dralle H, Frilling A, Gherl RG, Brandi ML, Limbert E, Niederle B, Forgas L, Rosenberg-Bourgin M, Calmettes C, and The European Study Group: Pheochromocytoma in multiple endocrine neoplasia type 2: European study. J Intern Med 1995, 238:363-367. The authors performed a retrospective review from eight European countries and studied the main characteristics of patients with pheochromocytoma and MEN UB. The data included 274 patients with MEN IIA and 26 with MEN IIB. Important features of the pheochromocytomas included 1) first occurrence in roughly 25% of the cases, 2) a malignancy rate for these tumors of only 4%, and 3) 64% of the 39 deaths in the series were linked to pheochromocytoma.
4. John LC, Levine A, Rees GM: Postural palpitations: a curious presentation of intrathoracic pheochromocytoma. Thorac Cardiovasc Surg 1995, 43:234-235. This is a case report of a patient with an intrathoracic pheochromocytoma first seen with postural palpitations. In addition to the case report, the authors present a review of extra-adrenal pheochromocytomas with a special emphasis on intrathoracic pheochromocytomas.
5. Fitzgerald PJ, Ports TA, Cheitlin MD, Magilligan DJ, Tyrrell JB: Intracardiac pheochromocytoma with dual coronary blood supply: case report and literature review. Thorac Cardiovasc Surg 1995, 3:557-561. This is a case report of an intracardiac pheochromocytoma. In this report the authors describe a patient who was first seen 20 years before the diagnosis with clinical signs and symptoms suggestive of the diagnosis of pheochromocytoma. However, radiologic studies were unable to confirm the diagnosis. Twenty years later, the patient was seen with chest pain, palpitations, and flushing. Cardiac catheterization demonstrated a tumor blush, and MRI identified the mass lesion in the heart. The authors reviewed the literature regarding cardiac-associated pheochromocytomas.
6. Chen H, Doppman JL, Chrousos GP, Norton JA, Nieman LK, Udelsman R: Adrenocorticotropic hormone-secreting pheochromocytomas: the exception to the rule. Surgery 1995, 118:988-995. The authors report a series of four patients first seen with ACTH-secreting pheochromocytomas. The authors make a number of points concerning ACTH-secreting pheochromocytomas in this paper; they review experience to date with this very rare tumor type. The authors make the point that an occult pheochromocytoma should be part of the differential diagnosis for any patient with a clinical picture suggestive of ectopic ACTH secretion.
7. Pickard JL, Ross G Jr, Silver D: Coexisting extra-adrenal pheochromocytomas and renal artery stenosis: a case report and review of the pathophysiology. J Pediatr Surg 1995, 30:1613-1615. The authors report the case of an 8-year-old boy presenting with coexisting malignant extra-adrenal pheochromocytoma and ipsilateral renal artery stenosis (RAS). The authors review the literature on the association between RAS and pheochromocytoma and list the possible mechanisms for renal artery stenosis in this situation (direct compression of the tumor mass on the renal artery, catecholamine-induced vasospasm, fibromuscular hyperplasia, and adhesions).
8. Januszewicz W, Wocial B: Pheochromocytoma: the catecholamine dependent hypertension. J Physiol Pharmacol 1995, 46:285-295. In this paper the authors described their experience with diagnosis and management of pheochromocytoma and reviewed the existing literature regarding the controversies in the treatment of patients with this tumor.
9. 123 MIBG is impaired in patients with pheochromocytoma, and they discuss the various possible causes of this observed reduction of cardiac MIBG uptake.
10. Alsabeh R, Mazoujian G, Goates J, Medeiros LJ, Weiss LM: Adrenal cortical tumors clinically mimicking pheochromocytoma. Am J Clin Pathol 1995, 104:382-390. The authors report five patients with adrenal cortical tumors with a diagnosis of pheochromocytoma made before surgical intervention. In two of the cases, histology revealed adrenal cortical carcinoma; the remainder of the tumors were adrenal cortical adenomas. Immunohistochemical and ultrastructural findings were consistent with adrenal cortical neoplasms in each case. The authors review the literature and make a few general comments concerning this very rare entity.
11. Tormey WP, FitzGerald RJ: The clinical and laboratory correlates of an increased urinary 5-hydroxyindoleacetic acid. Postgrad Med J 1995, 71:542-545. This paper describes the experience of a laboratory with requests for urinary 5-HIAA 24-hour collection studies. The authors reviewed the charts of each patient for whom a 24-hour urine study for 5-HIAA was requested. This paper is valuable because it reviews the various diagnoses that can be associated with elevated 5-HIAA levels and the various drugs that interfere with the test. Various other causes, in addition to drugs, that lead to falsely elevated urinary 5-HIAA levels are also discussed.
12. Crossey PA, Eng C, Ginalska-Malinowska M, Lennard TW, Wheeler DC, Ponder BA, Maher ER: Molecular genetic diagnosis of von Hippel-Lindau disease in familial phaeochromocytoma. J Med Genet 1995, 32:885-886. An investigation of three kindreds affected with pheochromocytoma to identify mutations for the RET proto-oncogene (signifying MEN II syndrome) or the VHL mutation (signifying von Hippel-Lindau disease).
13. des Senanayake P, Denker J, Bravo EL, Graham RM: Production, characterization, and expression of neuropeptide Y by human pheochromocytoma. J Clin Invest 1995, 96:2503-2509. A study of neuropeptide Y (NPY) levels in plasma and tumors of patients with pheochromocytoma. Levels of NPY (particularly the bioactive mature form of neuropeptide) were significantly higher in adrenal tumors than in extra-adrenal tumors. NPY fragments were elevated in extra-adrenal pheochromocytomas.
14. Nakada T, Sasagawa I, Kubota Y, Suzuki H, Ishigooka M, Watanabe M: Dihydroxyphenylglycol in pheochromocytoma: its diagnostic use for norepinephrine dominant tumor. J Urol 1996, 155:14-18. Levels of dehydroxyphenolglycol, epinephrine, and norepinephrine were all higher in pheochromocytomas than in the normal adrenal medulla. A high ratio of norepinephrine to dehydroxyphenolglycol in the urine indicated norepinephrine-dominant type pheochromocytoma.
15. Obara T, Kanbe M, Okamoto T, Ito Y, Yamashita T, Ito K, Hirose K, Yamazaki K, Hagihara J, Kusakabe K, Kohno A, Fujimoto Y: Surgical strategy for pheochromocytoma: emphasis on the pledge of flank extraperitoneal approach in selected patients. Surgery 1995, 118(suppl6):1083-1089. Obara and associates reported on 87 patients with pheochromocytoma; 17.5% of these patients had pheochromocytoma as part of a MEN syndrome. These authors concluded that with the current expertise and accuracy in preoperative localization studies, an extraperitoneal approach is justifiable for most patients, especially those with sporadic disease. Because the interval between initial operation and recurrence in the contralateral gland will be long for patients with MEN syndromes, these patients too may benefit from unilateral flank approach.
16. Rutherford JC, Gordon RD, Stowasser M, Tunny TJ, Klemm SA: Laparoscopic adrenalectomy for adrenal tumours causing hypertension and for "incidentalomas" of the adrenal on computerized tomography scanning. Clin Exp Pharmacol Physiol 1995, 22:490-492. This paper describes the experience of a single institution with laparoscopic surgery for adrenal tumors. The authors presented the results of their operations as well as the recovery and complication rates. They noted that patients treated with a laparoscopic surgical approach to the adrenal gland have a significant reduction in recovery time and a low complication rate. Because of their success and the low morbidity rates associated with this procedure, the authors recommended lowering the size for exploration of undiagnosed adrenal masses to 2.5 cm.
17. Platts JK, Drew PJ, Harvey JN: Death from phaeochromocytoma: lessons from a post-mortem survey. J R Coll Physicians Lond 1995, 29(suppl 4):299-306. These authors performed a retrospective survey of 62 deaths from pheochromocytoma. They noted that a large percentage of autopsies is necessary to estimate reliably the number of undiagnosed pheochromocytomas. In this series, 50% of pheochromocytomas were unsuspected during life. Pheochromocytoma was the cause of death for 25% of the patients.
18. Dabrowska B, Dabrowski A, Pruszczyk P, Skrobowski A, Wocial B: Heart rate variability in pheochromocytoma. Am J Cardiol 1995, 76:1202-1204. The authors assessed the autonomic cardiac activity of patients with pheochromocytoma by using heart-rate variability measurements. Their studies indicated that parasympathetic tone is higher among patients with pheochromocytoma than among patients with primary hypertension. They noted the presence of an unusual spectral form of vagal activity during excessive β-adrenergic stimulation. Persistent hypertension with excessive α-adrenergic stimulation was responsible for low cardiac sympathetic tone.
19. Scott IU, Gutterman DD: Pheochromocytoma with reversible focal cardiac dysfunction. Am Heart J 1995, 130:909-911. This is a case report of a patient seen with the unusual triad of chest pressure, hypotension, and an accelerated junctional rhythm. A diagnosis of pheochromocytoma was made after the patient was unsuccessfully treated for vasospasm. This case illustrates the necessity of maintaining a high index of suspicion for pheochromocytoma.
20. Dabrowska B, Pruszczyk P, Dabrowski A, Feltynowski T, Wocial B, Januszewicz W: Influence of α-adrenergic blockade on ventricular arrhythmias, QTc interval and heart rate variability in phaeochromocytoma. J Hum Hypertens 1995, 9:925-929. In this paper the authors assess the effect of α-adrenergic blockade in patients with pheochromocytoma. They monitored EKG and blood pressure as well as the urinary catecholamine excretion formed during treatment with nonselective α-blockers. Their findings indicate that nonselective α-blockade significantly decreased the incidence of frequent or repetitive ventricular arrhythmias in patients with pheochromocytoma. Moreover, nonselective α-blockade in pheochromocytoma patients significantly diminished vagal activity.
21. Vazquez-Quintana E, Vargas R, Perez M, Porro R, Gomez Duarte C, Tellado M, Marcial M: Pheochromocytoma and gastrointestinal bleeding. Am Surg 1995, 61:937-939. A case report of a patient who presented with an abdominal mass and gastrointestinal bleeding associated with an extra-adrenal pheochromocytoma. The authors provide a review of the literature for gastrointestinal complications of pheochromocytomas. They point out the paucity of data regarding gastrointestinal bleeding and this unusual tumor.