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Normotensive pheochromocytoma: institutional experience.
Amit Agarwal1, Sushil Gupta, Anand Kumar Mishra
1Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226 014, India. amit@sgpgi.ac.in
World Journal of Surgery
|August 11, 2005
Summary
This study highlights normotensive pheochromocytoma, a rare condition often presenting with abdominal pain. Early diagnosis and management, including alpha-adrenergic blockade, are crucial for successful surgical outcomes.
Area of Science:
- Endocrinology
- Surgical Oncology
- Nephrology
Background:
- Pheochromocytoma is a rare tumor of the adrenal medulla.
- Normotensive pheochromocytoma presents without hypertension, complicating diagnosis.
- This is the first reported series of normotensive pheochromocytoma from India.
Purpose of the Study:
- To audit cases of subclinical or normotensive pheochromocytoma.
- To review demographic, clinical, biochemical, imaging, and surgical data.
- To emphasize the distinct nature of normotensive pheochromocytoma and its management.
Main Methods:
- Retrospective review of nine patients with subclinical/normotensive pheochromocytoma (1990-2003).
- Inclusion criteria: no prior hypertension history.
- Data collected: demographics, presentation, biochemical tests (urinary metanephrine), imaging (CT, ultrasound), surgical notes, and follow-up.
Main Results:
- All nine patients presented with flank/abdominal pain and were normotensive.
- Seven patients had elevated urinary metanephrine levels.
- All patients underwent surgery after alpha-adrenergic blockade (prazosin), with six requiring intraoperative sodium nitroprusside; histopathology confirmed pheochromocytoma.
Conclusions:
- Normotensive pheochromocytoma is a distinct clinical entity.
- Adrenal incidentalomas warrant investigation for catecholamine hypersecretion.
- Preoperative alpha-adrenergic blockade and management similar to hypertensive pheochromocytoma are recommended.