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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
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated
