Pheochromocytoma natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pheochromocytoma}} | {{Pheochromocytoma}} | ||
{{CMG}} {{AE}} {{AAM}} | {{CMG}}; {{AE}} {{AAM}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Pheochromocytoma is an [[adrenaline]] secreting [[tumor]], that usually develops in the fifth decade of life. Symptoms start with [[tachycardia]], [[hypertension]], [[headache]] and [[sweating]]. Massive release of [[catecholamines]] may cause [[hyperglycemia]], [[malignant hypertension]] and [[metastasis]]. The [[prognosis]] of pheochromocytoma is generally good but metastatic pheochromocytoma has a 5-year survival rate of approximately 50%. | |||
==Natural History, | ==Natural History, Complications and Prognosis== | ||
=== | ===Natural History=== | ||
The | * The symptoms of pheochromocytoma usually develop in the fifth decade of life. | ||
* Common symptoms are with [[tachycardia]], [[hypertension]], [[headache]], and [[sweating]]. | |||
*[[ | * If left untreated, [[hyperglycemia]] and [[Hypertensive crisis|hypertensive emergency]]. It may lead to [[heart failure]] and[[Stroke|cerebrovascular strokes]]. | ||
*[[ | * If [[malignant]], It can [[metastasize]] to [[lymph nodes]], [[bones]], [[lungs]], and [[liver]]. <ref name="pmid28324046">{{cite journal| author=Pamporaki C, Hamplova B, Peitzsch M, Prejbisz A, Beuschlein F, Timmers HJLM et al.| title=Characteristics of Pediatric vs Adult Pheochromocytomas and Paragangliomas. | journal=J Clin Endocrinol Metab | year= 2017 | volume= 102 | issue= 4 | pages= 1122-1132 | pmid=28324046 | doi=10.1210/jc.2016-3829 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28324046 }}</ref> | ||
*[[ | |||
*[[Metastasis]] to [[ | ===Complications=== | ||
Common complications of pheochromocytoma include: | |||
* Damage to [[cardiac myocytes]] due to either a compromise of the [[coronary microcirculation]] or the direct toxic effects of [[catecholamines]] on [[cardiac myocytes]].<ref name="Goldman_327">{{Harvnb|Goldman|2011|pp=327}}</ref> | |||
*[[Hyperglycemia]] due to opposition of [[insulin]] effect by high doses of [[adrenaline]] secreted by the [[tumor]]. | |||
*[[Malignant hypertension]] that may cause [[Cerebrovascular event|cerebrovascular]] accidents such as: | |||
**[[Intracranial hemorrhage]] | |||
**[[Acute coronary syndrome]] | |||
**[[Aortic dissection]] | |||
**[[Heart failure]] | |||
*[[Metastasis]] to: | |||
**[[Lymph node|Lymph nodes]] | |||
**[[Bones]] | |||
**[[Lung|Lungs]] | |||
**[[Liver]] | |||
===Prognosis=== | ===Prognosis=== | ||
The 5-year survival in the | * The [[prognosis]] of pheochromocytoma is generally good with treatment. The 5-year survival rate in patients with [[metastatic]] pheochromocytoma is approximately 50%.<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/pheochromocytoma/hp/pheochromocytoma-treatment-pdq#link/_25_toc</ref> | ||
* Prognosis and survival rate varies with the location of the primary [[tumor]], sites of [[Metastasis|metastases]], [[Tumor]] burden, and rate of progression. | |||
* [[Metastasis]] to the [[brain]] and [[liver]] has a worse [[prognosis]] than other [[metastases]]. | |||
'''Post-surgical prognosis''' | |||
* Factors associated with a favourable [[prognosis]] include: | |||
** Small [[tumor]] size | |||
** Short duration of surgery | |||
** [[Systolic blood pressure]] < 160 mmHg | |||
** Low levels of [[urinary]] [[catecholamines]].<ref name="pmid20336320">{{cite journal| author=Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS, Larkin AC et al.| title=Trends in adrenalectomy: a recent national review. | journal=Surg Endosc | year= 2010 | volume= 24 | issue= 10 | pages= 2518-26 | pmid=20336320 | doi=10.1007/s00464-010-0996-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20336320 }}</ref> | |||
* Approximately 10% recur after being [[Resection|resected]]. | |||
* Recurrence is more common in patients with familial pheochromocytoma and extra-[[Adrenal gland|adrenal]] [[tumors]].<ref name="pmid11297571">{{cite journal| author=Plouin PF, Duclos JM, Soppelsa F, Boublil G, Chatellier G| title=Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 4 | pages= 1480-6 | pmid=11297571 | doi=10.1210/jcem.86.4.7392 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11297571 }}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
Latest revision as of 20:21, 28 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]
Overview
Pheochromocytoma is an adrenaline secreting tumor, that usually develops in the fifth decade of life. Symptoms start with tachycardia, hypertension, headache and sweating. Massive release of catecholamines may cause hyperglycemia, malignant hypertension and metastasis. The prognosis of pheochromocytoma is generally good but metastatic pheochromocytoma has a 5-year survival rate of approximately 50%.
Natural History, Complications and Prognosis
Natural History
- The symptoms of pheochromocytoma usually develop in the fifth decade of life.
- Common symptoms are with tachycardia, hypertension, headache, and sweating.
- If left untreated, hyperglycemia and hypertensive emergency. It may lead to heart failure andcerebrovascular strokes.
- If malignant, It can metastasize to lymph nodes, bones, lungs, and liver. [1]
Complications
Common complications of pheochromocytoma include:
- Damage to cardiac myocytes due to either a compromise of the coronary microcirculation or the direct toxic effects of catecholamines on cardiac myocytes.[2]
- Hyperglycemia due to opposition of insulin effect by high doses of adrenaline secreted by the tumor.
- Malignant hypertension that may cause cerebrovascular accidents such as:
- Metastasis to:
Prognosis
- The prognosis of pheochromocytoma is generally good with treatment. The 5-year survival rate in patients with metastatic pheochromocytoma is approximately 50%.[3]
- Prognosis and survival rate varies with the location of the primary tumor, sites of metastases, Tumor burden, and rate of progression.
- Metastasis to the brain and liver has a worse prognosis than other metastases.
Post-surgical prognosis
- Factors associated with a favourable prognosis include:
- Small tumor size
- Short duration of surgery
- Systolic blood pressure < 160 mmHg
- Low levels of urinary catecholamines.[4]
- Approximately 10% recur after being resected.
- Recurrence is more common in patients with familial pheochromocytoma and extra-adrenal tumors.[5]
References
- ↑ Pamporaki C, Hamplova B, Peitzsch M, Prejbisz A, Beuschlein F, Timmers HJLM; et al. (2017). "Characteristics of Pediatric vs Adult Pheochromocytomas and Paragangliomas". J Clin Endocrinol Metab. 102 (4): 1122–1132. doi:10.1210/jc.2016-3829. PMID 28324046.
- ↑ Goldman 2011, pp. 327
- ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/pheochromocytoma/hp/pheochromocytoma-treatment-pdq#link/_25_toc
- ↑ Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS, Larkin AC; et al. (2010). "Trends in adrenalectomy: a recent national review". Surg Endosc. 24 (10): 2518–26. doi:10.1007/s00464-010-0996-z. PMID 20336320.
- ↑ Plouin PF, Duclos JM, Soppelsa F, Boublil G, Chatellier G (2001). "Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center". J Clin Endocrinol Metab. 86 (4): 1480–6. doi:10.1210/jcem.86.4.7392. PMID 11297571.