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Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis.
[adrenal incidentaloma]
Present
knowledge
about
intraoperative
management
,
morbidity
,
and
mortality
of
patients
with
undiagnosed
catecholamine-producing
tumors
is
mostly
based
on
published
case
reports
and
anecdotal
evidence
.
The
aim
was
to
summarize
the
management
and
outcomes
of
reported
cases
and
analyze
for
practice
patterns
,
deduct
useful
management
recommendations
as
applicable
.
The
Medline
database
was
searched
with
specific
keywords
for
the
period
of
1988
-
2010
for
cases
of
incidental
pheochromocytomas
and
paragangliomas
.
Case
reports
in
the
English
language
with
a
postoperative
diagnosis
of
pheochromocytoma
and
paraganglioma
by
histopathology
were
included
.
Systematic
data
extraction
from
case
reports
was
done
.
Descriptive
statistics
were
applied
.
Of
823
retrieved
records
,
62
case
reports
met
inclusion
criteria
.
Hemodynamic
instability
occurred
primarily
during
mass
manipulation
/
intraoperatively
(
52
%
,
n
=
32
)
and
induction
/
laryngoscopy
(
18
%
,
n
=
11
)
.
In
cases
reporting
specific
antihypertensive
treatments
,
nitrates
(
67
%
,
n
=
30
)
represented
the
majority
of
medications
used
,
followed
by
beta
-blockers
(
47
%
,
n
=
21
)
.
Alpha
receptor
blockers
were
administered
in
33
%
(
n
=
15
)
.
The
perioperative
mortality
was
8
%
(
n
=
5
)
,
and
none
of
these
patients
received
intraoperative
alpha
blockade
.
A
catecholamine-secreting
tumor
was
suspected
intraoperatively
in
26
%
of
cases
.
The
perioperative
mortality
based
on
the
reviewed
cases
of
incidental
catecholamine
producing
tumors
was
less
than
would
traditionally
be
expected
.
Intraoperative
alpha
receptor
blockade
to
treat
hypertension
was
reported
in
33
%
of
cases
,
and
none
of
the
patients
with
a
fatal
outcome
had
received
it
.
A
higher
intraoperative
index
of
suspicion
and
a
lower
threshold
to
consider
alpha
blocking
medications
for
severe
intraoperative
hypertension
may
improve
outcomes
.
Diseases
Validation
Diseases presenting
"published case reports and anecdotal evidence"
symptom
adrenal incidentaloma
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