Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma
ABSTRACT Adrenal and extra-adrenal phaeochromocytoma are chromaffin cell-derived tumours that are discovered due to classical symptom triad with headache, sweating and palpitations combined with persistent or paroxysmal hypertension. However, an increasing proportion of phaeochromocytoma seems to be discovered incidentally upon abdominal imaging.
To specify the exact circumstances of discovery of adrenal and extra-adrenal phaeochromocytoma.
Four German endocrine centres participated in this retrospective study. MEDICAL: records of 201 patients with adrenal and extra-adrenal phaeochromocytoma who were diagnosed between 1973 and 2007 were analyzed.
The typical triad of symptoms was found only in 10% of cases. Ten percent of patients presented were without clinical symptoms and 6.1% were normotensive. Documented blood pressure peaks occurred in 44.1% of cases. In 24 patients (12.2%), phaeochromocytoma was malignant. Before 1985, <10% of cases were incidentally discovered, whereas thereafter the frequency was >25% (29.4% of the total study population). Patients with incidentally detected phaeochromocytoma were significantly older (53.1+/-1.9 vs 47.0+/-1.3 years; P<0.05) and often had less blood pressure peaks (37.0 vs 70.7%; P<0.001) than patients in whom the diagnosis was suspected on clinical grounds. Of phaeochromocytomas 94.4% were intra-adrenal tumours, of which 12.9% were bilateral. Bilateral tumours were significantly smaller than unilateral tumours (36.6+/-14.7 vs 52.5+/-34.3 mm; P<0.05), whereas extra-adrenal tumours had a mean diameter of 52.6+/-28.7 mm.
Owing to better availability and accessibility of imaging procedures, the number of incidentally discovered phaeochromocytoma is increasing and reaches nearly 30% in our study population. Every adrenal incidentaloma should be investigated for the presence of phaeochromocytoma.
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ABSTRACT: Pheochromocytomas are thought to be uncommon in the elderly. However, the prevalence is likely to be higher than reported, as older patients are less likely to be diagnosed due to absence of classical symptoms of sympathetic overactivity and confounding effects of aging, comorbidities, and medications. We describe a hypertensive elderly patient with incidentally diagnosed pheochromocytoma complicated by recurrent urosepsis, cardiomyopathy, and fatal myocardial infarction. Our case demonstrates that, in older hypertensive patients without classical symptoms, orthostatic hypotension and urinary retention, which are common in the elderly, may indicate catecholamine excess and that the deleterious cardiovascular consequences of catecholamine excess in the elderly are not prevented by pharmacological α- and β-blockade.09/2011; 2011:759523. DOI:10.1155/2011/759523
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ABSTRACT: Das Phäochromozytom manifestiert sich in bis zu 90% aller Fälle durch einen permanenten oder labilen Hypertonus. Durch eine massive Katecholaminausschüttung kann es insbesondere während der intraoperativen Tumormanipulation zu lebensbedrohlichen Blutdruckkrisen kommen. Seit den 1950er Jahren wird zur Prävention solcher Ereignisse erfolgreich die präoperative medikamentöse α-Rezeptoren-Blockade durchgeführt. In jüngerer Zeit werden als Nebenbefund von CT- oder MRT-Untersuchungen vermehrt Phäochromozytome diagnostiziert, die bis zu diesem Zeitpunkt asymptomatisch verlaufen sind. Über diese Art des Phäochromozytoms wurde in der Literatur bisher wenig berichtet. Der vorliegende Beitrag beschäftigt sich auf dem Boden der aktuellen Studienlage mit der Frage, ob eine präoperative α-Rezeptoren-Blockade auch beim asymptomatischen Phäochromozytom indiziert ist.Der Chirurg 06/2012; 83(6). DOI:10.1007/s00104-011-2195-4 · 0.52 Impact Factor
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