Pheochromocytoma secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
Effective measures for the secondary prevention of [[pheochromocytoma]] include [[biochemical]] [[Screening (medicine)|screening]] for family members of [[MEN2]] patients is mandatory and [[Genetic]] testing in first-degree relatives of a patient with proven [[germline]] ''[[RET proto-oncogene|RET]]'' [[mutation]]. | |||
==Secondary Prevention== | ==Secondary Prevention== | ||
* | ===Biochemical screening=== | ||
* According to the Endocrine Society, [[biochemical]] [[Screening (medicine)|screening]] for pheochromocytoma in recommended among patients with: | |||
** | ** [[Von Hippel-Lindau tumor suppressor|VHL syndrome]]- started at 5 years of age with [[biochemical]] surveillance every year for the rest of life. | ||
** | ** Signs or symptoms suggesting catecholamine excess, especially if the symptoms are paroxysmal. | ||
* | ** Unexpected blood pressure changes to drugs, surgery, or anesthesia | ||
** Unexplained blood pressure variability | |||
** Incidentaloma, even if the patient is normotensive | |||
** Blood pressure that is difficult to control | |||
** History of previous treatment for pheochromocytoma or paraganglioma | |||
** Hereditary risk of pheochromocytoma or paraganglioma in family members | |||
** Syndromic features relating to a pheochromocytoma-related hereditary syndromes <ref name="pmid24893135">{{cite journal| author=Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH | display-authors=etal| title=Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 6 | pages= 1915-42 | pmid=24893135 | doi=10.1210/jc.2014-1498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24893135 }} </ref> | |||
*[[Plasma]] fractionated [[metanephrine]] level is the best test. If elevated, 24-hour [[urinary]] fractionated [[Metanephrine|metanephrines]] should be done. | |||
==References== | ===Imaging screening=== | ||
[[Anatomic]] imaging should be used when [[norepinephrine]] levels are elevated more than two times upper normal limits.<ref name="pmid26451910">{{cite journal| author=Aufforth RD, Ramakant P, Sadowski SM, Mehta A, Trebska-McGowan K, Nilubol N et al.| title=Pheochromocytoma Screening Initiation and Frequency in von Hippel-Lindau Syndrome. | journal=J Clin Endocrinol Metab | year= 2015 | volume= 100 | issue= 12 | pages= 4498-504 | pmid=26451910 | doi=10.1210/jc.2015-3045 | pmc=4667160 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26451910 }}</ref> | |||
* For high-risk children, [[Screening (medicine)|screening]] for pheochromocytoma should begin by 11 years of age. | |||
* For moderate-risk patients, [[Screening (medicine)|screening]] should be started by 16 years of age. | |||
* If positive, [[Adrenal gland|adrenal]] imaging ([[Computed tomography|CT]]) or ([[Magnetic resonance imaging|MRI]]) should be performed. | |||
=== Genetic screening === | |||
* Genetic testing should be performed in:<ref name="pmid24893135">{{cite journal| author=Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH et al.| title=Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 6 | pages= 1915-42 | pmid=24893135 | doi=10.1210/jc.2014-1498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24893135 }}</ref> | |||
** Patients with a [[family history]] of pheochromocytoma | |||
**[[Tumors]] or [[malignant]] or extra-[[Adrenal gland|adrenal]] pheochromocytoma | |||
** Families whose infants or young children have [[Hirschsprung's disease|Hirschsprung disease]] | |||
**[[First degree relative|First-degree relatives]] of a patient with proven [[Germline mutation|germline]] ''[[RET proto-oncogene|RET]]'' [[mutation]] | |||
** Patients with [[cutaneous]] lichen [[amyloidosis]] | |||
** Patients with known ''[[RET proto-oncogene|RET]]'' mutations. | |||
** Parents whose young children have [[Multiple endocrine neoplasia type 2|MEN 2A/2B]] | |||
== References == | |||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 22:27, 28 July 2020
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Pheochromocytoma secondary prevention On the Web |
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Risk calculators and risk factors for Pheochromocytoma secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Effective measures for the secondary prevention of pheochromocytoma include biochemical screening for family members of MEN2 patients is mandatory and Genetic testing in first-degree relatives of a patient with proven germline RET mutation.
Secondary Prevention
Biochemical screening
- According to the Endocrine Society, biochemical screening for pheochromocytoma in recommended among patients with:
- VHL syndrome- started at 5 years of age with biochemical surveillance every year for the rest of life.
- Signs or symptoms suggesting catecholamine excess, especially if the symptoms are paroxysmal.
- Unexpected blood pressure changes to drugs, surgery, or anesthesia
- Unexplained blood pressure variability
- Incidentaloma, even if the patient is normotensive
- Blood pressure that is difficult to control
- History of previous treatment for pheochromocytoma or paraganglioma
- Hereditary risk of pheochromocytoma or paraganglioma in family members
- Syndromic features relating to a pheochromocytoma-related hereditary syndromes [1]
- Plasma fractionated metanephrine level is the best test. If elevated, 24-hour urinary fractionated metanephrines should be done.
Imaging screening
Anatomic imaging should be used when norepinephrine levels are elevated more than two times upper normal limits.[2]
- For high-risk children, screening for pheochromocytoma should begin by 11 years of age.
- For moderate-risk patients, screening should be started by 16 years of age.
- If positive, adrenal imaging (CT) or (MRI) should be performed.
Genetic screening
- Genetic testing should be performed in:[1]
- Patients with a family history of pheochromocytoma
- Tumors or malignant or extra-adrenal pheochromocytoma
- Families whose infants or young children have Hirschsprung disease
- First-degree relatives of a patient with proven germline RET mutation
- Patients with cutaneous lichen amyloidosis
- Patients with known RET mutations.
- Parents whose young children have MEN 2A/2B
References
- ↑ 1.0 1.1 Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH; et al. (2014). "Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline". J Clin Endocrinol Metab. 99 (6): 1915–42. doi:10.1210/jc.2014-1498. PMID 24893135.
- ↑ Aufforth RD, Ramakant P, Sadowski SM, Mehta A, Trebska-McGowan K, Nilubol N; et al. (2015). "Pheochromocytoma Screening Initiation and Frequency in von Hippel-Lindau Syndrome". J Clin Endocrinol Metab. 100 (12): 4498–504. doi:10.1210/jc.2015-3045. PMC 4667160. PMID 26451910.