Introduction: We present a case of a 29-year-old patient treated due to fully symptomatic pheochromocytoma of the right adrenal gland. Case presentation: Patient was operated on and an open right-sided adrenalectomy was performed. At the time of the surgery, a rupture of the tumor capsule occurred. Five years post-operatively, a recurrence of the symptoms of chromaffin-cell tumor was noted. After the exact localization of the multiple recurrences, the patient was reoperated on. Conclusion: The case of pheochromocytoma is presented due to the possibility of chromaffin-cell seeding into the peritoneum, with no signs of distal metastases so far.
Pheochromocytomas are rare tumors arising from the adrenal medulla. The diagnosis of malignancy remains a dogma between surgeon, pathologist and oncologist. We present a case of voluminous pheochromocytoma in a 53-year-old female patient, suspect of malignancy in the pathologic examination, while emphasizing the importance of the clinical and radiological long-term monitoring.
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The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.
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The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.
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We apply the dynamic decomposition of Poincaré plots, which is a computationally intensive, visual method of analysing physiological time series, to the analysis of the interbeat interval variability, systolic blood pressure, stroke volume and total peripheral resistance which were simultaneously recorded from a patient with pheochromocytoma and rapid, repetitive haemodynamic changes over 6 hours. The resulting animation is analysed and interpreted. It is found that changes in total peripheral resistance usually precede those of other variables, and the magnitude of changes is greatest for this variable. It is demonstrated that the decomposition of Poincaré plots of multivariate signals can visualise both the order and the extent of ongoing instant changes.
Pheochromocytoma and paraganglioma derive from chromaffin tissue that secretes catecholamines, which determine the characteristic clinical picture of the disease. Serious and potentially fatal cardiovascular complications require rapid diagnosis and treatment. The available biochemical tests are recommended not only to patients with characteristic clinical symptoms, but also to all patients with incidentally identified adrenal tumours. There is a growing incidence of diagnosed germline mutations associated with familial pheochromocytoma and paraganglioma in tumours originally identified as the sporadic form, and therefore current recommendations ever more often indicate the need for genetic testing in all patients with diagnosed pheochromocytoma or paraganglioma. Surgical treatment, which is the treatment of choice, brings very good results in the case of benign tumours, and even the malignant ones, provided they are operational. Unfortunately, there is no sufficiently good and efficacious alternative treatment for patients with unresectable or metastatic malignant tumours.
INTRODUCTION: Because of technological development and easier accessibility to diagnostic imaging, incidentally detected adrenal tumors are a frequently diagnosed endocrine disorder. The aim of the paper was to present the characteristics of patients with newly incidentally detected adrenal tumors, with emphasis on the detected hormonal disorders. MATERIAL AND METHODS: A retrospective, single center study included 96 patients hospitalized due to newly detected adrenal tumor between 2007 and 2014. RESULTS: Adrenal tumors were detected in 92 patients. The final diagnoses were: incidentaloma – 73 (76%), nodular adrenal hyperplasia – 12 (12.5%), pheochromocytoma – 5 (5.2%), late-onset congenital adrenal hyperplasia – 5 (5.2%), Conn’s syndrome – 1 (1.1%). In 94 out of the 96 patients at least one hormonal disorder was detected. The most frequent abnormalities were: incorrect plasma renin activity (67.7% of patients), evening serum cortisol concentration (60.2%, mean level: 8.9 µg%) and morning (48.9%, mean level: 15.4 µg%). A considerable group of patients suffered from comorbidities, such as hypertension (70.8%), impaired glucose tolerance (18.7%) and type 2 diabetes (16.7%). Additionally, the diameter of the tumors was negatively (p < 0.05) associated with the serum ACTH level. CONCLUSIONS: In most of the patients with incidentaloma, despite the lack of characteristic symptoms, it is possible to detect hormonal disorders in laboratory tests. The prevalence of hypertension and diabetes is high in this population of patients.
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WSTĘP: Wraz z gwałtownym postępem technicznym i zwiększoną dostępnością badań obrazowych przypadkowo wykryte guzy nadnerczy stały się częstym problemem endokrynologicznym. Celem pracy była charakterystyka pacjentów z przypadkowo wykrytymi guzami nadnerczy, ze szczególnym uwzględnieniem wykrywanych nieprawidłowości hormonalnych. MATERIAŁ I METODY: Retrospektywne jednoośrodkowe badanie objęło 96 pacjentów (21 mężczyzn i 75 kobiet w wieku 28–88 lat, mediana 62 lata), hospitalizowanych w latach 2007–2014 z powodu nowo wykrytych guzów nadnerczy. WYNIKI: Guzy nadnerczy zostały przypadkowo wykryte u 92 pacjentów. Po przeprowadzeniu diagnostyki rozpoznano: gruczolaki nadnercza – incydentaloma – w 73 przypadkach (76%), guzkowy przerost nadnerczy w 12 (12,5%), guzy chromochłonne w 5 (5,2%), późno wykryte wrodzone przerosty nadnerczy w 5 (5,2%) oraz zespół Conna w 1 przypadku (1,1%). Co najmniej jedno zaburzenie hormonalne wykryto u 94 spośród 96 pacjentów. Najczęstszymi zaburzeniami były: nieprawidłowa aktywność reninowa osocza (67,7% pacjentów), nieprawidłowe wieczorne stężenie kortyzolu (60,2%, średnie stężenie: 8,9 µg%) i poranne (48,9%, średnie stężenie: 15,4 µg%). Znaczna grupa pacjentów cierpiała na choroby współistniejące: nadciśnienie tętnicze (70,8%), nieprawidłową tolerancję glukozy (18,7%) i cukrzycę typu 2 (16,7%). Ponadto wykazano odwrotną korelację (p < 0,05) największego wymiaru guza ze stężeniem ACTH. WNIOSKI: U większości pacjentów z przypadkowo wykrytymi guzami nadnerczy, pomimo braku charakterystycznych objawów, można wykryć nieprawidłowości w badaniach hormonalnych. Nadciśnienie i cukrzyca występują u tych pacjentów częściej niż w populacji ogólnej.
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