Pheochromocytoma - Revision history

Danny.Quy.Le: Organization

2022-09-28T02:48:54Z

Organization

← Older revision		Revision as of 19:48, 27 September 2022
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	\| other_names =		\| other_names =
	\| anesthetic_relevance = Critical		\| anesthetic_relevance = Critical
			\| anesthetic_management = Refer to "Excision of pheochromocytoma"
	\| specialty = Endocrinology		\| specialty = Endocrinology
	\| signs_symptoms = Hypertension		\| signs_symptoms = Hypertension
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	\| caption =		\| caption =
	}}A '''pheochromocytoma''' is a rare neuroendocrine disease of the adrenal gland where catecholamine-secreting tumors cause hypertension. Pheochromocytoma is present in 0.05%<ref>{{Cite journal\|last=Lo\|first=Chung-Yau\|last2=Lam\|first2=King-Yin\|last3=Wat\|first3=Ming-Sun\|last4=Lam\|first4=Karen S.\|date=2000-03-01\|title=Adrenal pheochromocytoma remains a frequently overlooked diagnosis\|url=https://www.americanjournalofsurgery.com/article/S0002-9610(00)00296-8/abstract\|journal=The American Journal of Surgery\|language=English\|volume=179\|issue=3\|pages=212–215\|doi=10.1016/S0002-9610(00)00296-8\|issn=0002-9610\|pmid=10827323}}</ref> - 0.2%<ref name=":0">{{Cite book\|last=Yeh\|first=Michael\|url=https://www.worldcat.org/oclc/1235959889\|title=Sabiston textbook of surgery : the biological basis of modern surgical practice\|last2=Livhits\|first2=Masha\|last3=Duh\|first3=Quan-Yang\|date=2022\|publisher=\|others=Courtney M., Jr. Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox, David C. Sabiston\|year=\|isbn=978-0-323-64064-0\|edition=21st\|location=St. Louis, Missour\|pages=\|chapter=The Adrenal Glands\|oclc=1235959889}}</ref> of hypertensive individuals, the incidence of the disease presents equally between men and women with a distribution across age groups but peaks in between 40 and 50 years of age. The classic presentation of the disease is a triad of symptoms including headache, palpitations, diaphoresis with a documented clinical sign of hypertension (present in 90% of patients with pheochromocytoma)<ref name=":2">{{Cite journal\|last=Peramunage\|first=Dasun\|last2=Nikravan\|first2=Sara\|date=2020-03-01\|title=Anesthesia for Endocrine Emergencies\|url=https://www.anesthesiology.theclinics.com/article/S1932-2275(19)30088-6/abstract\|journal=Anesthesiology Clinics\|language=English\|volume=38\|issue=1\|pages=149–163\|doi=10.1016/j.anclin.2019.10.006\|issn=1932-2275\|pmid=32008649}}</ref>. However, patients can often present with less definitive symptoms such as tremor, anxiety, flushing, weight loss, and hyperglycemia. While the majority of pheochromocytoma emerges from adrenal tumors, roughly 15-20% can be extra-adrenal in etiology.		}}A '''pheochromocytoma''' is a rare neuroendocrine disease of the adrenal gland where catecholamine-secreting tumors cause hypertension. Pheochromocytoma is present in 0.05%<ref>{{Cite journal\|last=Lo\|first=Chung-Yau\|last2=Lam\|first2=King-Yin\|last3=Wat\|first3=Ming-Sun\|last4=Lam\|first4=Karen S.\|date=2000-03-01\|title=Adrenal pheochromocytoma remains a frequently overlooked diagnosis\|url=https://www.americanjournalofsurgery.com/article/S0002-9610(00)00296-8/abstract\|journal=The American Journal of Surgery\|language=English\|volume=179\|issue=3\|pages=212–215\|doi=10.1016/S0002-9610(00)00296-8\|issn=0002-9610\|pmid=10827323}}</ref> - 0.2%<ref name=":0">{{Cite book\|last=Yeh\|first=Michael\|url=https://www.worldcat.org/oclc/1235959889\|title=Sabiston textbook of surgery : the biological basis of modern surgical practice\|last2=Livhits\|first2=Masha\|last3=Duh\|first3=Quan-Yang\|date=2022\|publisher=\|others=Courtney M., Jr. Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox, David C. Sabiston\|year=\|isbn=978-0-323-64064-0\|edition=21st\|location=St. Louis, Missour\|pages=\|chapter=The Adrenal Glands\|oclc=1235959889}}</ref> of hypertensive individuals, the incidence of the disease presents equally between men and women with a distribution across age groups but peaks in between 40 and 50 years of age. The classic presentation of the disease is a triad of symptoms including headache, palpitations, diaphoresis with a documented clinical sign of hypertension (present in 90% of patients with pheochromocytoma)<ref name=":2">{{Cite journal\|last=Peramunage\|first=Dasun\|last2=Nikravan\|first2=Sara\|date=2020-03-01\|title=Anesthesia for Endocrine Emergencies\|url=https://www.anesthesiology.theclinics.com/article/S1932-2275(19)30088-6/abstract\|journal=Anesthesiology Clinics\|language=English\|volume=38\|issue=1\|pages=149–163\|doi=10.1016/j.anclin.2019.10.006\|issn=1932-2275\|pmid=32008649}}</ref>. However, patients can often present with less definitive symptoms such as tremor, anxiety, flushing, weight loss, and hyperglycemia. While the majority of pheochromocytoma emerges from adrenal tumors, roughly 15-20% can be extra-adrenal in etiology.

	~~== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==~~

	~~=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===~~

	~~=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===~~

	~~=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===~~

	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==

WikiAnesthesia at 19:59, 4 September 2022

2022-09-04T19:59:15Z

← Older revision		Revision as of 12:59, 4 September 2022
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	\| image =		\| image =
	\| caption =		\| caption =
	}}		}}A '''pheochromocytoma''' is a rare neuroendocrine disease of the adrenal gland where catecholamine-secreting tumors cause hypertension. Pheochromocytoma is present in 0.05%<ref>{{Cite journal\|last=Lo\|first=Chung-Yau\|last2=Lam\|first2=King-Yin\|last3=Wat\|first3=Ming-Sun\|last4=Lam\|first4=Karen S.\|date=2000-03-01\|title=Adrenal pheochromocytoma remains a frequently overlooked diagnosis\|url=https://www.americanjournalofsurgery.com/article/S0002-9610(00)00296-8/abstract\|journal=The American Journal of Surgery\|language=English\|volume=179\|issue=3\|pages=212–215\|doi=10.1016/S0002-9610(00)00296-8\|issn=0002-9610\|pmid=10827323}}</ref> - 0.2%<ref name=":0">{{Cite book\|last=Yeh\|first=Michael\|url=https://www.worldcat.org/oclc/1235959889\|title=Sabiston textbook of surgery : the biological basis of modern surgical practice\|last2=Livhits\|first2=Masha\|last3=Duh\|first3=Quan-Yang\|date=2022\|publisher=\|others=Courtney M., Jr. Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox, David C. Sabiston\|year=\|isbn=978-0-323-64064-0\|edition=21st\|location=St. Louis, Missour\|pages=\|chapter=The Adrenal Glands\|oclc=1235959889}}</ref> of hypertensive individuals, the incidence of the disease presents equally between men and women with a distribution across age groups but peaks in between 40 and 50 years of age. The classic presentation of the disease is a triad of symptoms including headache, palpitations, diaphoresis with a documented clinical sign of hypertension (present in 90% of patients with pheochromocytoma)<ref name=":2">{{Cite journal\|last=Peramunage\|first=Dasun\|last2=Nikravan\|first2=Sara\|date=2020-03-01\|title=Anesthesia for Endocrine Emergencies\|url=https://www.anesthesiology.theclinics.com/article/S1932-2275(19)30088-6/abstract\|journal=Anesthesiology Clinics\|language=English\|volume=38\|issue=1\|pages=149–163\|doi=10.1016/j.anclin.2019.10.006\|issn=1932-2275\|pmid=32008649}}</ref>. However, patients can often present with less definitive symptoms such as tremor, anxiety, flushing, weight loss, and hyperglycemia. While the majority of pheochromocytoma emerges from adrenal tumors, roughly 15-20% can be extra-adrenal in etiology.

	'''~~Pheochromocytoma~~''' is a rare neuroendocrine disease of the adrenal gland where catecholamine-secreting tumors cause hypertension. Pheochromocytoma is present in 0.05%<ref>{{Cite journal\|last=Lo\|first=Chung-Yau\|last2=Lam\|first2=King-Yin\|last3=Wat\|first3=Ming-Sun\|last4=Lam\|first4=Karen S.\|date=2000-03-01\|title=Adrenal pheochromocytoma remains a frequently overlooked diagnosis\|url=https://www.americanjournalofsurgery.com/article/S0002-9610(00)00296-8/abstract\|journal=The American Journal of Surgery\|language=English\|volume=179\|issue=3\|pages=212–215\|doi=10.1016/S0002-9610(00)00296-8\|issn=0002-9610\|pmid=10827323}}</ref> - 0.2%<ref name=":0">{{Cite book\|last=Yeh\|first=Michael\|url=https://www.worldcat.org/oclc/1235959889\|title=Sabiston textbook of surgery : the biological basis of modern surgical practice\|last2=Livhits\|first2=Masha\|last3=Duh\|first3=Quan-Yang\|date=2022\|publisher=\|others=Courtney M., Jr. Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox, David C. Sabiston\|year=\|isbn=978-0-323-64064-0\|edition=21st\|location=St. Louis, Missour\|pages=\|chapter=The Adrenal Glands\|oclc=1235959889}}</ref> of hypertensive individuals, the incidence of the disease presents equally between men and women with a distribution across age groups but peaks in between 40 and 50 years of age. The classic presentation of the disease is a triad of symptoms including headache, palpitations, diaphoresis with a documented clinical sign of hypertension (present in 90% of patients with pheochromocytoma)<ref name=":2">{{Cite journal\|last=Peramunage\|first=Dasun\|last2=Nikravan\|first2=Sara\|date=2020-03-01\|title=Anesthesia for Endocrine Emergencies\|url=https://www.anesthesiology.theclinics.com/article/S1932-2275(19)30088-6/abstract\|journal=Anesthesiology Clinics\|language=English\|volume=38\|issue=1\|pages=149–163\|doi=10.1016/j.anclin.2019.10.006\|issn=1932-2275\|pmid=32008649}}</ref>. However, patients can often present with less definitive symptoms such as tremor, anxiety, flushing, weight loss, and hyperglycemia. While the majority of pheochromocytoma emerges from adrenal tumors, roughly 15-20% can be extra-adrenal in etiology.

	== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==		== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==
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	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==
			* [[Excision of pheochromocytoma]]

	== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==		== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==

Danny.Quy.Le at 15:48, 19 July 2021

2021-07-19T15:48:51Z

← Older revision		Revision as of 08:48, 19 July 2021
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	* Psychiatric Manifestations		* Psychiatric Manifestations
	** Anxiety		** Anxiety
	** Panic attacks<ref>{{Cite journal\|last=Reisch\|first=Nicole\|last2=Peczkowska\|first2=Mariola\|last3=Januszewicz\|first3=Andrzej\|last4=Neumann\|first4=Hartmut P. H.\|date=2006~~-12~~\|title=Pheochromocytoma: presentation, diagnosis and treatment\|url=https://pubmed.ncbi.nlm.nih.gov/17082709\|journal=Journal of Hypertension\|volume=24\|issue=12\|pages=2331–2339\|doi=10.1097/01.hjh.0000251887.01885.54\|issn=0263-6352\|pmid=17082709}}</ref>		** Panic attacks<ref>{{Cite journal\|last=Reisch\|first=Nicole\|last2=Peczkowska\|first2=Mariola\|last3=Januszewicz\|first3=Andrzej\|last4=Neumann\|first4=Hartmut P. H.\|date=2006\|title=Pheochromocytoma: presentation, diagnosis and treatment\|url=https://pubmed.ncbi.nlm.nih.gov/17082709\|journal=Journal of Hypertension\|volume=24\|issue=12\|pages=2331–2339\|doi=10.1097/01.hjh.0000251887.01885.54\|issn=0263-6352\|pmid=17082709\|via=}}</ref>

	Rarely, patients can present with “pheochromocytoma crisis” which manifests with hypertension or hypotension, hyperthermia, mental status change, and other organ dysfunction.<ref>{{Cite journal\|last=Kakoki\|first=Katsura\|last2=Miyata\|first2=Yasuyoshi\|last3=Shida\|first3=Youhei\|last4=Hakariya\|first4=Tomoaki\|last5=Takehara\|first5=Kosuke\|last6=Izumida\|first6=Seiya\|last7=Sekino\|first7=Motohiro\|last8=Kinoshita\|first8=Naoe\|last9=Igawa\|first9=Tsukasa\|last10=Fukuoka\|first10=Junya\|last11=Sakai\|first11=Hideki\|date=2015-12-09\|title=Pheochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review\|url=https://pubmed.ncbi.nlm.nih.gov/26645353\|journal=BMC research notes\|volume=8\|pages=758\|doi=10.1186/s13104-015-1738-z\|issn=1756-0500\|pmc=4673852\|pmid=26645353}}</ref>		Rarely, patients can present with “pheochromocytoma crisis” which manifests with hypertension or hypotension, hyperthermia, mental status change, and other organ dysfunction.<ref>{{Cite journal\|last=Kakoki\|first=Katsura\|last2=Miyata\|first2=Yasuyoshi\|last3=Shida\|first3=Youhei\|last4=Hakariya\|first4=Tomoaki\|last5=Takehara\|first5=Kosuke\|last6=Izumida\|first6=Seiya\|last7=Sekino\|first7=Motohiro\|last8=Kinoshita\|first8=Naoe\|last9=Igawa\|first9=Tsukasa\|last10=Fukuoka\|first10=Junya\|last11=Sakai\|first11=Hideki\|date=2015-12-09\|title=Pheochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review\|url=https://pubmed.ncbi.nlm.nih.gov/26645353\|journal=BMC research notes\|volume=8\|pages=758\|doi=10.1186/s13104-015-1738-z\|issn=1756-0500\|pmc=4673852\|pmid=26645353}}</ref>
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	When equivocal results occur, a '''clonidine suppression test''' can be used. Clonidine is an alpha-2 adrenergic antagonist and decreases catecholamine levels. In patients with pheochromocytoma, clonidine will fail to suppress the catecholamine levels.<ref>{{Cite journal\|last=Wan\|first=WingYee\|last2=Nguyen\|first2=Bichle\|last3=Graybill\|first3=Sky\|last4=Kim\|first4=Jonathan\|date=2019-06-25\|title=Clonidine suppression testing for pheochromocytoma in neurofibromatosis type 1\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605898/\|journal=BMJ Case Reports\|volume=12\|issue=6\|doi=10.1136/bcr-2018-228263\|issn=1757-790X\|pmc=6605898\|pmid=31243023}}</ref>		When equivocal results occur, a '''clonidine suppression test''' can be used. Clonidine is an alpha-2 adrenergic antagonist and decreases catecholamine levels. In patients with pheochromocytoma, clonidine will fail to suppress the catecholamine levels.<ref>{{Cite journal\|last=Wan\|first=WingYee\|last2=Nguyen\|first2=Bichle\|last3=Graybill\|first3=Sky\|last4=Kim\|first4=Jonathan\|date=2019-06-25\|title=Clonidine suppression testing for pheochromocytoma in neurofibromatosis type 1\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605898/\|journal=BMJ Case Reports\|volume=12\|issue=6\|doi=10.1136/bcr-2018-228263\|issn=1757-790X\|pmc=6605898\|pmid=31243023}}</ref>

	Many drugs and conditions can affect the levels of catecholamines and its metabolites. Therefore it is important to minimize these confounding variables. Before these diagnostic tests, it is important to discontinue any interfering medications including sympathomimetics, tricyclic antidepressants, acetaminophen. Patients should also avoid caffeine, strenuous physical activity, and smoking 12 hours prior to testing. Plasma samples should also be drawn following 30 minutes of supine rest.<ref name=":0" /><ref>{{Cite journal\|last=Shah\|first=U.\|last2=Giubellino\|first2=A.\|last3=Pacak\|first3=K.\|date=2012~~-06~~\|title=Pheochromocytoma: implications in tumorigenesis and the actual management\|url=https://pubmed.ncbi.nlm.nih.gov/22691888\|journal=Minerva Endocrinologica\|volume=37\|issue=2\|pages=141–156\|issn=0391-1977\|pmc=3409463\|pmid=22691888}}</ref>		Many drugs and conditions can affect the levels of catecholamines and its metabolites. Therefore it is important to minimize these confounding variables. Before these diagnostic tests, it is important to discontinue any interfering medications including sympathomimetics, tricyclic antidepressants, acetaminophen. Patients should also avoid caffeine, strenuous physical activity, and smoking 12 hours prior to testing. Plasma samples should also be drawn following 30 minutes of supine rest.<ref name=":0" /><ref>{{Cite journal\|last=Shah\|first=U.\|last2=Giubellino\|first2=A.\|last3=Pacak\|first3=K.\|date=2012\|title=Pheochromocytoma: implications in tumorigenesis and the actual management\|url=https://pubmed.ncbi.nlm.nih.gov/22691888\|journal=Minerva Endocrinologica\|volume=37\|issue=2\|pages=141–156\|issn=0391-1977\|pmc=3409463\|pmid=22691888\|via=}}</ref>

	'''Imaging'''~~<!-- Describe diagnostic imaging~~		'''Imaging'''
	~~-->~~

	Radiological evaluation follows biochemical confirmation to locate the tumor. 95% of pheochromocytomas are located within the abdomen and pelvis but 15% are extra-adrenal.		Radiological evaluation follows biochemical confirmation to locate the tumor. 95% of pheochromocytomas are located within the abdomen and pelvis but 15% are extra-adrenal.
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	* '''Iobenguane I-123''' can be used in a setting of negative MRI or CT results but high clinical suspicion particularly for multifocal disease with a sensitivity of 85-88% and specificity of 70-100%. Iobenguane I-123 is a compound similar to norepinephrine that is taken up in adrenergic tissue like pheochromocytoma.		* '''Iobenguane I-123''' can be used in a setting of negative MRI or CT results but high clinical suspicion particularly for multifocal disease with a sensitivity of 85-88% and specificity of 70-100%. Iobenguane I-123 is a compound similar to norepinephrine that is taken up in adrenergic tissue like pheochromocytoma.

	* '''Fludeoxyglucose-positron emission tomography (FDG-PET)''' and '''68-Ga Dotatate PET''' are highly sensitive tests (74-100%) with best performance in metastatic disease. However, there is limited availability of these relatively newer modalities at academic centers.<ref>{{Cite journal\|last=Čtvrtlík\|first=Filip\|last2=Koranda\|first2=Pavel\|last3=Schovánek\|first3=Jan\|last4=Škarda\|first4=Jozef\|last5=Hartmann\|first5=Igor\|last6=Tüdös\|first6=Zbyněk\|date=2018~~-04~~\|title=Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy\|url=https://pubmed.ncbi.nlm.nih.gov/29545830\|journal=Experimental and Therapeutic Medicine\|volume=15\|issue=4\|pages=3151–3160\|doi=10.3892/etm.2018.5871\|issn=1792-0981\|pmc=5840941\|pmid=29545830}}</ref><ref>{{Cite journal\|last=Janssen\|first=Ingo\|last2=Chen\|first2=Clara C.\|last3=Millo\|first3=Corina M.\|last4=Ling\|first4=Alexander\|last5=Taieb\|first5=David\|last6=Lin\|first6=Frank I.\|last7=Adams\|first7=Karen T.\|last8=Wolf\|first8=Katherine I.\|last9=Herscovitch\|first9=Peter\|last10=Fojo\|first10=Antonio T.\|last11=Buchmann\|first11=Inga\|date=2016~~-09~~\|title=PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma\|url=https://pubmed.ncbi.nlm.nih.gov/26996779\|journal=European Journal of Nuclear Medicine and Molecular Imaging\|volume=43\|issue=10\|pages=1784–1791\|doi=10.1007/s00259-016-3357-x\|issn=1619-7089\|~~pmc~~=~~8194362~~\|~~pmid~~=~~26996779~~}}</ref><ref name=":1">{{Cite journal\|last=Lenders\|first=Jacques W. M.\|last2=Duh\|first2=Quan-Yang\|last3=Eisenhofer\|first3=Graeme\|last4=Gimenez-Roqueplo\|first4=Anne-Paule\|last5=Grebe\|first5=Stefan K. G.\|last6=Murad\|first6=Mohammad Hassan\|last7=Naruse\|first7=Mitsuhide\|last8=Pacak\|first8=Karel\|last9=Young\|first9=William F.\|date=2014~~-06-01~~\|title=Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline\|url=https://doi.org/10.1210/jc.2014-1498\|journal=The Journal of Clinical Endocrinology & Metabolism\|volume=99\|issue=6\|pages=1915–1942\|doi=10.1210/jc.2014-1498\|issn=0021-972X}}</ref>		* '''Fludeoxyglucose-positron emission tomography (FDG-PET)''' and '''68-Ga Dotatate PET''' are highly sensitive tests (74-100%) with best performance in metastatic disease. However, there is limited availability of these relatively newer modalities at academic centers.<ref>{{Cite journal\|last=Čtvrtlík\|first=Filip\|last2=Koranda\|first2=Pavel\|last3=Schovánek\|first3=Jan\|last4=Škarda\|first4=Jozef\|last5=Hartmann\|first5=Igor\|last6=Tüdös\|first6=Zbyněk\|date=2018\|title=Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy\|url=https://pubmed.ncbi.nlm.nih.gov/29545830\|journal=Experimental and Therapeutic Medicine\|volume=15\|issue=4\|pages=3151–3160\|doi=10.3892/etm.2018.5871\|issn=1792-0981\|pmc=5840941\|pmid=29545830\|via=}}</ref><ref>{{Cite journal\|last=Janssen\|first=Ingo\|last2=Chen\|first2=Clara C.\|last3=Millo\|first3=Corina M.\|last4=Ling\|first4=Alexander\|last5=Taieb\|first5=David\|last6=Lin\|first6=Frank I.\|last7=Adams\|first7=Karen T.\|last8=Wolf\|first8=Katherine I.\|last9=Herscovitch\|first9=Peter\|last10=Fojo\|first10=Antonio T.\|last11=Buchmann\|first11=Inga\|date=2016\|title=PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma\|url=https://pubmed.ncbi.nlm.nih.gov/26996779\|journal=European Journal of Nuclear Medicine and Molecular Imaging\|volume=43\|issue=10\|pages=1784–1791\|doi=10.1007/s00259-016-3357-x\|issn=1619-7089\|pmid=26996779\|via=}}</ref><ref name=":1">{{Cite journal\|last=Lenders\|first=Jacques W. M.\|last2=Duh\|first2=Quan-Yang\|last3=Eisenhofer\|first3=Graeme\|last4=Gimenez-Roqueplo\|first4=Anne-Paule\|last5=Grebe\|first5=Stefan K. G.\|last6=Murad\|first6=Mohammad Hassan\|last7=Naruse\|first7=Mitsuhide\|last8=Pacak\|first8=Karel\|last9=Young\|first9=William F.\|date=2014\|title=Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline\|url=https://doi.org/10.1210/jc.2014-1498\|journal=The Journal of Clinical Endocrinology & Metabolism\|volume=99\|issue=6\|pages=1915–1942\|doi=10.1210/jc.2014-1498\|issn=0021-972X\|via=}}</ref>

	'''Genetic Testing'''		'''Genetic Testing'''
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	'''Contraindicated Diagnostic Procedure'''		'''Contraindicated Diagnostic Procedure'''

	* '''Selective Adrenal Venous Sampling''' may result in falsely positive catecholamine levels and subsequent inappropriate adrenalectomy.<ref>{{Cite journal\|last=Freel\|first=E. Marie\|last2=Stanson\|first2=Anthony W.\|last3=Thompson\|first3=Geoffrey B.\|last4=Grant\|first4=Clive S.\|last5=Farley\|first5=David R.\|last6=Richards\|first6=Melanie L.\|last7=Young\|first7=William F.\|date=2010~~-03~~\|title=Adrenal venous sampling for catecholamines: a normal value study\|url=https://pubmed.ncbi.nlm.nih.gov/20061413\|journal=The Journal of Clinical Endocrinology and Metabolism\|volume=95\|issue=3\|pages=1328–1332\|doi=10.1210/jc.2009-2253\|issn=1945-7197\|pmid=20061413}}</ref>		* '''Selective Adrenal Venous Sampling''' may result in falsely positive catecholamine levels and subsequent inappropriate adrenalectomy.<ref>{{Cite journal\|last=Freel\|first=E. Marie\|last2=Stanson\|first2=Anthony W.\|last3=Thompson\|first3=Geoffrey B.\|last4=Grant\|first4=Clive S.\|last5=Farley\|first5=David R.\|last6=Richards\|first6=Melanie L.\|last7=Young\|first7=William F.\|date=2010\|title=Adrenal venous sampling for catecholamines: a normal value study\|url=https://pubmed.ncbi.nlm.nih.gov/20061413\|journal=The Journal of Clinical Endocrinology and Metabolism\|volume=95\|issue=3\|pages=1328–1332\|doi=10.1210/jc.2009-2253\|issn=1945-7197\|pmid=20061413\|via=}}</ref>
	* '''Ultrasound''' is not recommended given low sensitivity.<ref name=":1" />		* '''Ultrasound''' is not recommended given low sensitivity.<ref name=":1" />

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	* During the early 20th century, the perioperative mortality of this disease ranged between 26-50%.		* During the early 20th century, the perioperative mortality of this disease ranged between 26-50%.
	* As surgical technique and perioperative management has improved, the mortality has decreased to roughly 1% in specialized centers.		* As surgical technique and perioperative management has improved, the mortality has decreased to roughly 1% in specialized centers.
	* The largest North American series published about pheochromocytoma excision described 108 cases, where 90% were conducted laparoscopically, and the perioperative morbidity rate was 13% with no mortalities.<ref>{{Cite journal\|last=Shen\|first=Wen T.\|last2=Grogan\|first2=Raymon\|last3=Vriens\|first3=Menno\|last4=Clark\|first4=Orlo H.\|last5=Duh\|first5=Quan-Yang\|date=2010~~-09~~\|title=One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy\|url=https://pubmed.ncbi.nlm.nih.gov/20855761\|journal=Archives of Surgery (Chicago, Ill.: 1960)\|volume=145\|issue=9\|pages=893–897\|doi=10.1001/archsurg.2010.159\|issn=1538-3644\|pmid=20855761}}</ref>		* The largest North American series published about pheochromocytoma excision described 108 cases, where 90% were conducted laparoscopically, and the perioperative morbidity rate was 13% with no mortalities.<ref>{{Cite journal\|last=Shen\|first=Wen T.\|last2=Grogan\|first2=Raymon\|last3=Vriens\|first3=Menno\|last4=Clark\|first4=Orlo H.\|last5=Duh\|first5=Quan-Yang\|date=2010\|title=One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy\|url=https://pubmed.ncbi.nlm.nih.gov/20855761\|journal=Archives of Surgery (Chicago, Ill.: 1960)\|volume=145\|issue=9\|pages=893–897\|doi=10.1001/archsurg.2010.159\|issn=1538-3644\|pmid=20855761\|via=}}</ref>
	* For non-metastatic and metastatic pheochromocytomas, the 5-year survival rate is 97% and 84%, respectively.<ref>{{Cite journal\|last=Kim\|first=Jung Hee\|last2=Moon\|first2=Hyemi\|last3=Noh\|first3=Junghyun\|last4=Lee\|first4=Juneyoung\|last5=Kim\|first5=Sin Gon\|date=2020~~-03~~\|title=Epidemiology and Prognosis of Pheochromocytoma/Paraganglioma in Korea: A Nationwide Study Based on the National Health Insurance Service\|url=https://pubmed.ncbi.nlm.nih.gov/32207276\|journal=Endocrinology and Metabolism (Seoul, Korea)\|volume=35\|issue=1\|pages=157–164\|doi=10.3803/EnM.2020.35.1.157\|issn=2093-5978\|pmc=7090309\|pmid=32207276}}</ref>		* For non-metastatic and metastatic pheochromocytomas, the 5-year survival rate is 97% and 84%, respectively.<ref>{{Cite journal\|last=Kim\|first=Jung Hee\|last2=Moon\|first2=Hyemi\|last3=Noh\|first3=Junghyun\|last4=Lee\|first4=Juneyoung\|last5=Kim\|first5=Sin Gon\|date=2020\|title=Epidemiology and Prognosis of Pheochromocytoma/Paraganglioma in Korea: A Nationwide Study Based on the National Health Insurance Service\|url=https://pubmed.ncbi.nlm.nih.gov/32207276\|journal=Endocrinology and Metabolism (Seoul, Korea)\|volume=35\|issue=1\|pages=157–164\|doi=10.3803/EnM.2020.35.1.157\|issn=2093-5978\|pmc=7090309\|pmid=32207276\|via=}}</ref>

	== Epidemiology<!-- Describe the epidemiology of this comorbidity --> ==		== Epidemiology<!-- Describe the epidemiology of this comorbidity --> ==

Danny.Quy.Le at 15:37, 19 July 2021

2021-07-19T15:37:30Z

← Older revision		Revision as of 08:37, 19 July 2021
Line 75:		Line 75:
	Many drugs and conditions can affect the levels of catecholamines and its metabolites. Therefore it is important to minimize these confounding variables. Before these diagnostic tests, it is important to discontinue any interfering medications including sympathomimetics, tricyclic antidepressants, acetaminophen. Patients should also avoid caffeine, strenuous physical activity, and smoking 12 hours prior to testing. Plasma samples should also be drawn following 30 minutes of supine rest.<ref name=":0" /><ref>{{Cite journal\|last=Shah\|first=U.\|last2=Giubellino\|first2=A.\|last3=Pacak\|first3=K.\|date=2012-06\|title=Pheochromocytoma: implications in tumorigenesis and the actual management\|url=https://pubmed.ncbi.nlm.nih.gov/22691888\|journal=Minerva Endocrinologica\|volume=37\|issue=2\|pages=141–156\|issn=0391-1977\|pmc=3409463\|pmid=22691888}}</ref>		Many drugs and conditions can affect the levels of catecholamines and its metabolites. Therefore it is important to minimize these confounding variables. Before these diagnostic tests, it is important to discontinue any interfering medications including sympathomimetics, tricyclic antidepressants, acetaminophen. Patients should also avoid caffeine, strenuous physical activity, and smoking 12 hours prior to testing. Plasma samples should also be drawn following 30 minutes of supine rest.<ref name=":0" /><ref>{{Cite journal\|last=Shah\|first=U.\|last2=Giubellino\|first2=A.\|last3=Pacak\|first3=K.\|date=2012-06\|title=Pheochromocytoma: implications in tumorigenesis and the actual management\|url=https://pubmed.ncbi.nlm.nih.gov/22691888\|journal=Minerva Endocrinologica\|volume=37\|issue=2\|pages=141–156\|issn=0391-1977\|pmc=3409463\|pmid=22691888}}</ref>

	'''Imaging'''		'''Imaging'''<!-- Describe diagnostic imaging
			-->

	Radiological evaluation follows biochemical confirmation to locate the tumor. 95% of pheochromocytomas are located within the abdomen and pelvis but 15% are extra-adrenal.		Radiological evaluation follows biochemical confirmation to locate the tumor. 95% of pheochromocytomas are located within the abdomen and pelvis but 15% are extra-adrenal.

Danny.Quy.Le: Draft of Major Sections of Pheochromocytoma Page

2021-07-19T15:33:33Z

Draft of Major Sections of Pheochromocytoma Page

Show changes

Chris.Rishel at 08:53, 9 June 2021

2021-06-09T08:53:42Z

← Older revision		Revision as of 01:53, 9 June 2021
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	{{Infobox comorbidity		{{Infobox comorbidity
	\| other_names =		\| other_names =
	\| anesthetic_relevance =		\| anesthetic_relevance = Critical
	\| specialty =		\| specialty = Endocrinology
	\| signs_symptoms =		\| signs_symptoms = Hypertension
	\| diagnosis =		Headache
	\| treatment =		Diaphoresis
			Tachycardia
			\| diagnosis = Urine metanephrines and catecholamines
			Abdominal CT/MRI for localization
			\| treatment = Surgical resection
			Alpha/beta blockade
	\| image =		\| image =
	\| caption =		\| caption =
	}}		}}

	~~Provide~~ a ~~brief summary~~ of ~~this comorbidity here~~.		'''Pheochromocytoma''' is a rare neuroendocrine disease of the adrenal gland where catecholamine-secreting tumors cause hypertension. Pheochromocytoma is present in 0.05%<ref>{{Cite journal\|last=Lo\|first=Chung-Yau\|last2=Lam\|first2=King-Yin\|last3=Wat\|first3=Ming-Sun\|last4=Lam\|first4=Karen S.\|date=2000-03-01\|title=Adrenal pheochromocytoma remains a frequently overlooked diagnosis\|url=https://www.americanjournalofsurgery.com/article/S0002-9610(00)00296-8/abstract\|journal=The American Journal of Surgery\|language=English\|volume=179\|issue=3\|pages=212–215\|doi=10.1016/S0002-9610(00)00296-8\|issn=0002-9610\|pmid=10827323}}</ref> - 0.2%<ref>{{Cite book\|last=Yeh\|first=Michael\|url=https://www.worldcat.org/oclc/1235959889\|title=Sabiston textbook of surgery : the biological basis of modern surgical practice\|last2=Livhits\|first2=Masha\|last3=Duh\|first3=Quan-Yang\|date=2022\|publisher=\|others=Courtney M., Jr. Townsend, R. Daniel Beauchamp, B. Mark Evers, Kenneth L. Mattox, David C. Sabiston\|year=\|isbn=978-0-323-64064-0\|edition=21st\|location=St. Louis, Missour\|pages=\|chapter=The Adrenal Glands\|oclc=1235959889}}</ref> of hypertensive individuals, the incidence of the disease presents equally between men and women with a distribution across age groups but peaks in between 40 and 50 years of age. The classic presentation of the disease is a triad of symptoms including headache, palpitations, diaphoresis with a documented clinical sign of hypertension (present in 90% of patients with pheochromocytoma)<ref>{{Cite journal\|last=Peramunage\|first=Dasun\|last2=Nikravan\|first2=Sara\|date=2020-03-01\|title=Anesthesia for Endocrine Emergencies\|url=https://www.anesthesiology.theclinics.com/article/S1932-2275(19)30088-6/abstract\|journal=Anesthesiology Clinics\|language=English\|volume=38\|issue=1\|pages=149–163\|doi=10.1016/j.anclin.2019.10.006\|issn=1932-2275\|pmid=32008649}}</ref>. However, patients can often present with less definitive symptoms such as tremor, anxiety, flushing, weight loss, and hyperglycemia. While the majority of pheochromocytoma emerges from adrenal tumors, roughly 15-20% can be extra-adrenal in etiology.

	== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==		== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==
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	== References ==		== References ==
			<references />
	[[Category:Comorbidities]]		[[Category:Comorbidities]]

Nkamdar: Created outline

2021-05-20T17:02:35Z

Created outline

New page

{{Infobox comorbidity
| other_names =
| anesthetic_relevance =
| specialty =
| signs_symptoms =
| diagnosis =
| treatment =
| image =
| caption =
}}

Provide a brief summary of this comorbidity here.

== Anesthetic implications ==

=== Preoperative optimization ===

=== Intraoperative management ===

=== Postoperative management ===

== Related surgical procedures ==

== Pathophysiology ==

== Signs and symptoms ==

== Diagnosis ==

== Treatment ==

=== Medication ===

=== Surgery ===

=== Prognosis ===

== Epidemiology ==

== References ==

[[Category:Comorbidities]]