Pheochromocytomas are catecholamine-producing tumors that typically cause hypertension. They are rare tumors that can pose problems in diagnosis and detection. Although they usually present classic symptoms, they can at times present symptoms that mimic other clinical conditions. Especially, children have fewer malignant tumors, non-extra-adrenal tumors, and tumors with greater bilaterality and multiplicity. The diagnosis of pheochromocytomas is based upon clinical suspicion and biochemical study. Radiologic localization is obtained before operation because of the variable location of this tumor. The treatment of choice is surgical resection. We reports a case of asymptomatic pheochromocytoma that was treated with tumor excision. To prevent intraoperative and postoperative complications, precise preoperative diagnosis and localization, as well as adequate preoperative management, are necessary.
Child ; Diagnosis ; Humans ; Hypertension ; Pheochromocytoma* ; Postoperative Complications

Adrenal Cortex Neoplasms ; complications ; Adrenal Gland Neoplasms ; complications ; Adrenal Glands ; pathology ; Adrenocortical Adenoma ; complications ; Humans ; Pheochromocytoma ; complications

Adrenal Gland Neoplasms ; complications ; physiopathology ; Hemorrhage ; etiology ; Humans ; Male ; Middle Aged ; Peritoneal Diseases ; etiology ; Pheochromocytoma ; complications ; physiopathology

Pheochromocytoma in pregnancy is very rare but it is associated with very high maternal and fetal mortality. Therefore, it is important to include pheochromocytoma in the differential diagnosis of hypertension associated with pregnancy. It is difficult to make a diagnosis of pheochromocytoma in pregnancy before delivery. The characteristic symptoms of pheochromocytoma could be initiated during delivery because the process of delivery, general anesthesia, fetal movement, induce acute surge of catecholamine release, which could also induce cardiomyopathy. Early diagnosis and intensive care can affect the prognosis of cardiomyopathy induced by pheochromocytoma. Proper management with alpha-blockade, beta-blockade and angiotension converting enzyme inhibitor could acutely reverse the course of cardiomyopathy.
Adrenal Gland Neoplasms/surgery ; Adrenal Gland Neoplasms/diagnosis* ; Adrenal Gland Neoplasms/complications ; Adult ; Cardiovascular Agents/therapeutic use ; Disease-Free Survival ; Echocardiography ; Electrocardiography ; Female ; Human ; Myocardial Diseases/ultrasonography ; Myocardial Diseases/etiology* ; Myocardial Diseases/drug therapy ; Pheochromocytoma/surgery ; Pheochromocytoma/diagnosis* ; Pheochromocytoma/complications ; Pregnancy ; Pregnancy Complications, Cardiovascular/etiology* ; Pregnancy Complications, Neoplastic/surgery ; Pregnancy Complications, Neoplastic/diagnosis* ; Pregnancy Outcome* ; Puerperium ; Tomography, X-Ray Computed ; Substances: Cardiovascular Agents

Phaeochromocytomas are rare neuroendocrine tumours with variable clinical signs and symptoms. Hypertension, tachycardia, sweating and headaches are cardinal manifestations. Although nausea and abdominal pain are the more common gastrointestinal features, rare gastrointestinal spectrums have been reported that can mimic abdominal emergencies. Metabolic effects of hypercatecholaminaemia are vast and one such rare presentation is lactic acidosis. We describe a case of phaeochromocytoma presenting with both intestinal pseudo-obstruction as well as lactic acidosis. This case report highlights the importance of having a high index of suspicion for and early recognition of the gastrointestinal and metabolic manifestations of phaeochromocytomas.
Abdominal Pain ; Acidosis, Lactic ; complications ; Adrenal Gland Neoplasms ; complications ; diagnosis ; Diabetes Mellitus, Type 2 ; complications ; Dyslipidemias ; complications ; Female ; Humans ; Hypertension ; complications ; Intestinal Pseudo-Obstruction ; complications ; Middle Aged ; Neuroendocrine Tumors ; complications ; diagnosis ; Pheochromocytoma ; complications ; diagnosis ; Radiography, Abdominal

PURPOSE: While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, this procedure remains challenging for pheochromocytoma. The purpose of our investigation was to assess the perioperative profiles of laparoscopic adrenalectomy (LA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. MATERIALS AND METHODS: Between January 1997 and October 2005, 31 patients with pheochromocytoma underwent surgical removal, including 15 LA and 16 OA. The LA was performed via a lateral decubitus transperitoneal approach. The mean tumor size was similar in both groups (LA 6.0cm vs. OA 5.7cm). All patients underwent extensive preoperative medical preparation with alpha-blockers. The intraoperative hemodynamic instabilities and perioperative profiles were retrospectively analyzed. RESULTS: No conversion to open surgery was required with either procedure and no mortality was observed. Hypertensive crisis (systolic blood pressure>200mmHg) and severe tachycardia (heart rate>100/min) were more common in the OA group (LA 13.3 and 26.7% vs. OA 56.3 and 62.5%). The mean operating times for both groups were similar (LA 182.0+/-47.0 min vs. OA 183.1+/-66.5 min), but the duration of hospitalization was shorter in the LA group (LA 5.3+/-2.2 days vs. OA 6.8+/-1.0 days). The estimated blood loss was greater in the OA group (LA 103.3+/-44.2ml vs. OA 159.4+/-66.8ml). Intravenous morphine was needed in 56.3% of the OA, but in only 13.3% of the LA group. There were no significant differences in the postoperative complications between the two groups. CONCLUSIONS: The laparoscopic resection of pheochromocytomas can be accomplished safely and effectively. A short hospital stay, with minimal perioperative morbidity and the eradication of endocrinopathy, support the minimally invasive approach for adrenalectomy in patients with pheochromocytoma.
Adrenalectomy* ; Conversion to Open Surgery ; Hemodynamics ; Hospitalization ; Humans ; Laparoscopy ; Length of Stay ; Morphine ; Mortality ; Pheochromocytoma* ; Postoperative Complications ; Retrospective Studies ; Tachycardia

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgical Instruments

Pheochromocytoma is a rare cause of hypertension in children. Hypertension is one of the common reasons of posterior reversible encephalopathy. Intracerebral hemorrhage is a serious and unexpected complication of hypertensive encephalopathy due to pheochromocytoma, and very rarely seen in the childhood. Intracerebral hemorrhages should be searched if there are hypertensive reversible signal changes on the brain. Susceptibility weighted imaging (SWI) is a more sensitive method than conventional MRI when demonstrating cerebral microhemorrhagic foci. This is the first report of SWI findings on intracerebral hemorrhages in basal ganglia, brain stem and periventricular white matter due to hypertensive encephalopathy in a child with pheochromocytoma.
Adolescent ; Adrenal Gland Neoplasms/*complications/diagnosis ; Brain/*pathology ; Diagnosis, Differential ; Female ; Humans ; Hypertensive Encephalopathy/*diagnosis/etiology ; Magnetic Resonance Imaging/*methods ; Pheochromocytoma/*complications/diagnosis

Two patients underwent anesthesia for pheochromocytoma involving adrenal gland and extra- adrenal space. Patient 1 was not diagnosed as pheochromocytoma before surgery and thus proper preoperative evaluation and care was not possible. During surgery and anesthesia, the patient showed a marked blood pressure variation, arrythmia and tachycardia. Pulmonary edema occurred intraoperatively, but subsided with positive end expiratory pressure and the use of diuretics and morphine. Patient 2 was preoperatively diagnosed as pheochromocytoma and was thus given prazosin and nifedipine (for 11 days) preoperatively. Blood pressure and pulse rate throughout the surgery and anesthesia were stable and no intra- and postoperative complication occured. We believe that careful preoperative preparation is essential to minimize intraoperative hemo- dynamic disturbance and their sequelae.
Adrenal Glands ; Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Diuretics ; Heart Rate ; Humans ; Morphine ; Nifedipine ; Pheochromocytoma* ; Positive-Pressure Respiration ; Postoperative Complications ; Prazosin ; Pulmonary Edema ; Tachycardia

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.
Carbon ; Cystectomy ; Cystoscopy ; Humans ; India ; Ink ; Laparoscopy ; Length of Stay ; Muscles ; Needles ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Tattooing ; Urachal Cyst ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Catheterization ; Wound Healing