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Advances in the Diagnosis and Treatment of Pheochromocytoma

Advances in the Diagnosis and Treatment of Pheochromocytoma Abstract • Diagnosis and management of pheochromocytoma, once dangerous and uncertain, have been dramatically altered in recent years by advances in imaging, assays, and pharmaceuticals. During the past ten years we have treated 18 patients who had pheochromocytoma. Biochemical diagnosis was made In all patients by measurement of 24-hour urinary total catecholamine excretion or by epinephrine-norepinephrine fractionation. Determination of epinephrine-norepinephrine ratios was instrumental in making the diagnosis of pheochromocytoma in two patients in whom total catecholamine levels were normal. Localization of the pheochromocytoma in the most recently treated cases was accomplished by ultrasound, computed tomography, or iodine I 131 iobenguane (iodine I 131 metaiodobenzylguanidine) scanning. Nine patients in the series were prepared for surgery with phenoxybenzamine hydrochloride and six with prazosin hydrochloride. Preoperative total α-adrenergic blockade with phenoxybenzamine offered no advantage over selective blockade with prazosin in terms of perioperative fluid requirements or intraoperative hemodynamlc stability. (Arch Surg 1988;123:626-630) References 1. Manger WM, Gifford RM: Pheochromocytoma . New York, Springer-Verlag NY Inc, 1977. 2. Black HR, Bursten SL: A clinical scoring system for detection of patients with pheochromocytoma . Yale J Biol Med 1984;57:254-272. 3. Frier DT, Harrison TS, Donahue SM, et al: Rigorous biochemical criteria for the diagnosis of pheochromocytoma . J Surg Res 1973;14:177-180.Crossref 4. Gitlow SE, Mendlowitz M, Bertani LM: The biochemical techniques for detecting and establishing the presence of a pheochromocytoma . Am J Cardiol 1970;26:270-279.Crossref 5. Crout JR, Pisano JJ, Sjoerdsma A: Urinary excretion of catecholamines and their metabolites in pheochromocytoma . Am Heart J 1961;61:375-381.Crossref 6. Stewart BM, Brevo EL, Haaga J, et al: Localization of tumor by computed tomography . N Engl J Med 1978;299:460-461.Crossref 7. Rossi P, Young IS, Panke WF: Techniques, usefulness, and hazards of arteriography of pheochromocytoma: A review of 99 cases . JAMA 1968;205:547-553.Crossref 8. Harrison TS, Seaton JF, Cerny JC, et al: Localization of pheochromocytoma by caval catheterization . Arch Surg 1967;95:339-343.Crossref 9. Laursen K, Damgaard-Pedersen K: CT for pheochromocytoma diagnosis . AJR 1980;134:277-280.Crossref 10. Reinig JW, Doppman JL, Dwyer AJ, et al: Adrenal masses differentiated by MR . Radiology 1986;158:81-84.Crossref 11. Sisson JL, Frager MS, Valk TW, et al: Scintigraphic localization of pheochromocytoma . N Engl J Med 1981;305:12-17.Crossref 12. Mayo CH: Paroxysmal hypertension with tumor of retroperitoneal nerve . JAMA 1927;89:1047-1050.Crossref 13. Longino FH, Grimsan KS, Chittum JR, et al: Effects of a new quarternary amine and a new imidazole derivative on the autonomic nervous system . Surgery 1949;26:421-434. 14. Sjoerdsma A, Engelmann K, Waldmann TA, et al: Pheochromocytoma: Current concepts of diagnosis and treatment . Ann Intern Med 1966;65:1302-1326.Crossref 15. Ross EJ, Prichard BNC, Kaufman L, et al: Preoperative and operative management of patients with pheochromocytoma . Br Med J 1967;1:191-198.Crossref 16. Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974. 17. Bravo EL, Gifford RW Jr: Pheochromocytoma: Diagnosis, localization and management . N Engl J Med 1984;311:1298-1303.Crossref 18. van Heerden JA, Sheps SG, Hamburger B, et al: Pheochromocytoma: Current status and changing trends . Surgery 1982;91:367-373. 19. Desmonts JM, Marty J: Anaesthetic management of patients with pheochromocytoma . Br J Anaesth 1984;56:781-789.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Advances in the Diagnosis and Treatment of Pheochromocytoma

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References (25)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400290112020
Publisher site
See Article on Publisher Site

Abstract

Abstract • Diagnosis and management of pheochromocytoma, once dangerous and uncertain, have been dramatically altered in recent years by advances in imaging, assays, and pharmaceuticals. During the past ten years we have treated 18 patients who had pheochromocytoma. Biochemical diagnosis was made In all patients by measurement of 24-hour urinary total catecholamine excretion or by epinephrine-norepinephrine fractionation. Determination of epinephrine-norepinephrine ratios was instrumental in making the diagnosis of pheochromocytoma in two patients in whom total catecholamine levels were normal. Localization of the pheochromocytoma in the most recently treated cases was accomplished by ultrasound, computed tomography, or iodine I 131 iobenguane (iodine I 131 metaiodobenzylguanidine) scanning. Nine patients in the series were prepared for surgery with phenoxybenzamine hydrochloride and six with prazosin hydrochloride. Preoperative total α-adrenergic blockade with phenoxybenzamine offered no advantage over selective blockade with prazosin in terms of perioperative fluid requirements or intraoperative hemodynamlc stability. (Arch Surg 1988;123:626-630) References 1. Manger WM, Gifford RM: Pheochromocytoma . New York, Springer-Verlag NY Inc, 1977. 2. Black HR, Bursten SL: A clinical scoring system for detection of patients with pheochromocytoma . Yale J Biol Med 1984;57:254-272. 3. Frier DT, Harrison TS, Donahue SM, et al: Rigorous biochemical criteria for the diagnosis of pheochromocytoma . J Surg Res 1973;14:177-180.Crossref 4. Gitlow SE, Mendlowitz M, Bertani LM: The biochemical techniques for detecting and establishing the presence of a pheochromocytoma . Am J Cardiol 1970;26:270-279.Crossref 5. Crout JR, Pisano JJ, Sjoerdsma A: Urinary excretion of catecholamines and their metabolites in pheochromocytoma . Am Heart J 1961;61:375-381.Crossref 6. Stewart BM, Brevo EL, Haaga J, et al: Localization of tumor by computed tomography . N Engl J Med 1978;299:460-461.Crossref 7. Rossi P, Young IS, Panke WF: Techniques, usefulness, and hazards of arteriography of pheochromocytoma: A review of 99 cases . JAMA 1968;205:547-553.Crossref 8. Harrison TS, Seaton JF, Cerny JC, et al: Localization of pheochromocytoma by caval catheterization . Arch Surg 1967;95:339-343.Crossref 9. Laursen K, Damgaard-Pedersen K: CT for pheochromocytoma diagnosis . AJR 1980;134:277-280.Crossref 10. Reinig JW, Doppman JL, Dwyer AJ, et al: Adrenal masses differentiated by MR . Radiology 1986;158:81-84.Crossref 11. Sisson JL, Frager MS, Valk TW, et al: Scintigraphic localization of pheochromocytoma . N Engl J Med 1981;305:12-17.Crossref 12. Mayo CH: Paroxysmal hypertension with tumor of retroperitoneal nerve . JAMA 1927;89:1047-1050.Crossref 13. Longino FH, Grimsan KS, Chittum JR, et al: Effects of a new quarternary amine and a new imidazole derivative on the autonomic nervous system . Surgery 1949;26:421-434. 14. Sjoerdsma A, Engelmann K, Waldmann TA, et al: Pheochromocytoma: Current concepts of diagnosis and treatment . Ann Intern Med 1966;65:1302-1326.Crossref 15. Ross EJ, Prichard BNC, Kaufman L, et al: Preoperative and operative management of patients with pheochromocytoma . Br Med J 1967;1:191-198.Crossref 16. Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974. 17. Bravo EL, Gifford RW Jr: Pheochromocytoma: Diagnosis, localization and management . N Engl J Med 1984;311:1298-1303.Crossref 18. van Heerden JA, Sheps SG, Hamburger B, et al: Pheochromocytoma: Current status and changing trends . Surgery 1982;91:367-373. 19. Desmonts JM, Marty J: Anaesthetic management of patients with pheochromocytoma . Br J Anaesth 1984;56:781-789.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1988

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