TY - JOUR
T1 - Postoperative management in patients with Pheochromocytoma and Paraganglioma
AU - Mamilla, Divya
AU - Araque, Katherine
AU - Brofferio, Alessandra
AU - Gonzales, Melissa K.
AU - Sullivan, James N.
AU - Nilubol, Naris
AU - Pacak, Karel
N1 - Funding Information:
Funding: This article was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
Publisher Copyright:
© 2019 by the authors.
PY - 2019/7
Y1 - 2019/7
N2 - Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.
AB - Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.
KW - Arrhythmia
KW - Hypertension
KW - Hypotension
KW - Pheochromocytoma
KW - Postoperative
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U2 - 10.3390/cancers11070936
DO - 10.3390/cancers11070936
M3 - Review article
C2 - 31277296
AN - SCOPUS:85068716524
SN - 2072-6694
VL - 11
JO - Cancers
JF - Cancers
IS - 7
M1 - 936
ER -