Pheochromocytoma natural history, complications and prognosis: Difference between revisions

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===Complications===
===Complications===
* Common complications of pheochromocytoma include:
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><ref name="Goldman_327" />
* 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]].
*[[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:
*[[Malignant hypertension]] that may cause [[Cerebrovascular event|cerebrovascular]] accidents such as:
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===Prognosis===
===Prognosis===
* 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>  
* 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>  
* Approximately 10% recur after being [[Resection|resected]].
* Prognosis and survival rate varies with the location of the primary [[tumor]], sites of [[Metastasis|metastases]], [[Tumor]] burden, and rate of progression.
* 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]].
* [[Metastasis]] to the [[brain]] and [[liver]] has a worse [[prognosis]] than other [[metastases]].
'''Post-surgical prognosis'''
'''Post-surgical prognosis'''
*Features leading to a good [[prognosis]] include small [[tumor]] size, short duration of surgery, [[systolic blood pressure]] less than 160 mmHg, and 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>
* Factors associated with a favourable [[prognosis]] include:
*Postoperative [[hypotension]] can be avoided by adequate fluid replacement.
** Small [[tumor]] size
*Recurrence is more 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>
** Short duration of surgery
*Familial pheochromocytomas have a high [[incidence]] of bilateral disease.
** [[Systolic blood pressure]] < 160 mmHg
*Partial [[adrenalectomy]] is recommended for these patients with bilateral pheochromocytomas to prevent permanent [[glucocorticoid]] deficiency.
** 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>
*Complete bilateral [[adrenalectomy]] is recommended for [[Multiple endocrine neoplasia type 2|MEN2]]B patients. There is a high rate of recurrence compared to sporadic cases. Follow-up for a long duration after surgery is required. Most patients should undergo annual [[biochemical]] [[Screening (medicine)|screening]].
* 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==

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

Complications

Common complications of pheochromocytoma include:

Prognosis

Post-surgical prognosis

References

  1. 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.
  2. Goldman 2011, pp. 327
  3. National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/pheochromocytoma/hp/pheochromocytoma-treatment-pdq#link/_25_toc
  4. 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.
  5. 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.