Pheochromocytoma Crisis Is Not a Surgical Emergency
ABSTRACT Context:Pheochromocytoma crisis is a feared and potentially lethal complication of pheochromocytoma.Objective:We sought to determine the best treatment strategy for pheochromocytoma crisis patients and hypothesized that emergency resection is not indicated.Design:Retrospective cohort study (1993-2011); literature review (1944-2011).Setting:Tertiary referral center.Patients:There were 137 pheochromocytoma patients from our center and 97 pheochromocytoma crisis patients who underwent adrenalectomy from the literature.Intervention:Medical management of pheochromocytoma crisis; adrenalectomy.Main Outcome Measure(s):Perioperative complications, conversion, and mortality.Results:In our database, 25 patients (18%) presented with crisis. After medical stabilization and α-blockade, 15 patients were discharged and readmitted for elective surgery and 10 patients were operated on urgently during the same hospitalization. None underwent emergency surgery. Postoperatively, patients who underwent elective surgery had shorter hospital stays (1.7 vs 5.7 d, P = 0.001) and fewer postoperative complications (1 of 15 [7%] vs 5 of 10 [50%], P = 0.045) and were less often admitted to the intensive care unit (1 of 15 [7%] vs 5 of 10 [50%], P = 0.045) in comparison with urgently operated patients. There was no mortality. Review of the literature (n = 97) showed that crisis patients who underwent elective or urgent surgery vs emergency surgery had less intraoperative (13 of 31 [42%] vs 20 of 25 [80%], P < 0.001) and postoperative complications (15 of 45 [33%] vs 15 of 21 [71%], P = 0.047) and a lower mortality (0 of 64 vs 6 of 33 [18%], P = 0.002).Conclusions:Management of patients presenting with pheochromocytoma crisis should include initial stabilization of the acute crisis followed by sufficient α-blockade before surgery. Emergency resection of pheochromocytoma is associated with high surgical morbidity and mortality.
- SourceAvailable from: Federico PiscioneAmerican Journal of Emergency Medicine 04/2014; 32(8). DOI:10.1016/j.ajem.2014.04.040 · 1.15 Impact Factor
Article: Pheochromocytoma crisis.[Show abstract] [Hide abstract]
ABSTRACT: Pheochromocytoma crisis is an endocrine emergency associated with significant mortality. There is little published guidance on the management of pheochromocytoma crisis. This clinical practice update summarises the relevant published literature, including a detailed review of cases published in the past five years, and a proposed classification system. We review the recommended management of pheochromocytoma crisis including the use of alpha blockade, which is strongly associated with survival of a crisis. Mechanical circulatory supportive therapy (such as intra-aortic balloon pump or extra corporeal membrane oxygenation) is strongly recommended for patients with sustained hypotension. Surgical intervention should be deferred until medical stabilisation is achieved. This article is protected by copyright. All rights reserved.Clinical Endocrinology 09/2013; DOI:10.1111/cen.12324 · 3.35 Impact Factor
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ABSTRACT: Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case.10/2013; 2013:514714. DOI:10.1155/2013/514714