Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five weeks after developing spells of shortness of breath, headache, weakness and abdominal pain, a 29-year-old woman, who was in the 36th week of her third pregnancy developed adult respiratory distress syndrome (ARDS). Although the ARDS resolved after a cesarean section, her infant died at birth. Her "spells" continued until a left pheochromocytoma was diagnosed and resected 2 years later. If there are no other known inciting causes of ARDS in a pregnant patient, a pheochromocytoma should be ruled out with appropriate catecholamine determinations.
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PMID:Adult respiratory distress syndrome in a pregnant patient with a pheochromocytoma. 403 96

Previous reports of endocrine activity of glomus jugulare tumors have been of pheochromocytomas but not carcinoid apudomas. This paper is to alert the otolaryngologist to the presence of carcinoid apudomas in glomus jugulare tumors. A patient with a long history of explosive diarrhea, facial flushing, and violent headaches, the symptom of carcinoid syndrome, was cured after removal of his large glomus jugulare tumor. The diagnosis of carcinoid syndrome is made with a good history and confirmed with a 24 hour urine collection for 5 Hydroxy indole acetic acid (5 Hiaa). a series of patients treated at the Johns Hopkins Hospital for glomus jugulare tumors is reviewed for the presence of endocrine activity and the literature on endocrine active glomus jugulare tumors is presented. Preoperative evaluation for the presence of both pheochromocytoma and carcinoid apudoma is recommended for all patients with glomus jugulare tumors.
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PMID:Carcinoid apudoma arising in a glomus jugulare tumor: review of endocrine activity in glomus jugulare tumors. 624 85

Labetalol is a combined alpha- and beta-adrenoceptor blocking agent for oral and intravenous use in the treatment of hypertension. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. Labetalol is more potent at beta that at alpha 1 adrenoceptors in man; the ratio of beta-alpha antagonism is 3:1 after oral and 6.9:1 after intravenous administration. Labetalol is readily absorbed in man after oral administration, but the drug, which is lipid soluble, undergoes considerable hepatic first-pass metabolism and has an absolute bioavailability of approximately 25%. There are no active metabolites, and the elimination half-life of the drug is approximately 6 hours. Unlike conventional beta-adrenoceptor blocking drugs without intrinsic sympathomimetic activity, labetalol, when given acutely, produces a decrease in peripheral vascular resistance and blood pressure with little alteration in heart rate or cardiac output. However, like conventional beta-blockers, labetalol may influence the renin-angiotensin-aldosterone system and respiratory function. Clinical studies have shown that the antihypertensive efficacy of labetalol is superior to placebo and to diuretic therapy and is at least comparable to that of conventional beta-blockers, methyldopa, clonidine and various adrenergic neuronal blockers. Labetalol administered alone or with a diuretic is often effective when other antihypertensive regimens have failed. Studies have shown that labetalol is effective in the treatment of essential hypertension, renal hypertension, pheochromocytoma, pregnancy hypertension and hypertensive emergencies. In addition, preliminary studies indicate that labetalol may be of value in the management of ischemic heart disease. The most troublesome side effect of labetalol therapy is posture-related dizziness. Other reported side effects of the drug include gastrointestinal disturbances, tiredness, headache, scalp tingling, skin rashes, urinary retention and impotence. Side effects related to the beta-adrenoceptor blocking effect of labetalol, including asthma, heart failure and Raynaud's phenomenon, have been reported in rare instances.
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PMID:Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. 631 May 29

Pheochromocytoma is surgically curable, and lethal complications often ensue when the diagnosis is not made. We review 54 autopsy-proven cases of pheochromocytoma seen at the Mayo Clinic over the 50-year period 1928-1977. There were 31 females and 23 males, and the patients' ages ranged from 40 hours to 92 years (mean, 53 years). Pheochromocytoma was multiple in 10 patients (19%), extra-adrenal in 5 (9%), and malignant in 6 (11%). In 13 (24%) pheochromocytoma had been correctly diagnosed in life--after the investigation of hypertension in 8 patients, incidentally at laparotomy for unrelated conditions in 4 patients, and in association with the multiple endocrine neoplasia syndrome in 1 patient. In the group of 41 patients (76%) in whom pheochromocytoma had not been suspected clinically, hypertension also was a common finding (22 patients, 54%). Symptoms such as headache, sweating, and palpitations were nonspecific, but all occurred more often among the group of patients in whom the diagnosis had been made. For both groups, hypertensive or hypotensive or hypotensive crisis precipitated by surgery for unrelated conditions was a common cause of death. Prevention of such deaths requires a high degree of clinical alertness and biochemical screening tests for pheochromocytoma in patients with labile or accelerated hypertension.
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PMID:Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. 645 59

A 29-year-old female who had undergone resection of an abdominal paraaortic pheochromocytoma weighing 33 g at the age of 20 had had severe headaches, hypertension and hyperhidrosis 3 years prior to the surgery. Postoperatively, her symptoms completely disappeared and urinary catecholamines were normalized. She was well and had married and had had 2 children. She was admitted to our hospital on August 22, 1982, for further evaluation of hypertension (154/100), which had been diagnosed 2 months previously. Endocrinological studies confirming the presence of a pheochromocytoma were as follows: 1) Plasma noradrenaline level was significantly elevated to 1750 pg/ml. 2) Urinary catecholamine and their metabolites (Metanephrines and VMA) were markedly elevated. Her blood pressure was borderline hypertension and its diurnal rhythm was lost. Her blood pressure decreased to normal values after the oral administration of labetalol (100 mg). Plasma noradrenaline level was still high at 180 minutes after the oral administration of clonidine (150 micrograms). Hypertensive response to insulin-induced hypoglycemia (regular insulin 0.1 u/kg i.v.) was observed, but blood pressure returned to normal after the infusion of glucose alone. Hypertensive response to both metoclopramide (5 mg i.v.) and sulpiride (50 mg per os) was observed accompanying the significant elevation of plasma noradrenaline. Computed tomography and ultrasonography revealed a tumor localized between the aorta and the vena cava inferior. Selective venous sampling also revealed an intrathoracic pheochromocytoma. On October 8, 1982, a 28 g mass was removed from the mediastinum just above the diaphragma. Histologically, it was typical of a pheochromocytoma. Electron microscopy showed large polygonal cells with numerous large secretory granules characteristic of noradrenaline-granules. Postoperative blood pressure was normal, but repeated measurements of plasma and urinary catecholamines were still slightly high. We, therefore, followed her case carefully at our out-patient clinic. In order to clarify the mechanism of catecholamine release by metoclopramide and sulpiride, tissue cultures of removed pheochromocytoma with and without these drugs were carried out. The in vitro studies revealed that metoclopramide released noradrenaline eight-fold and sulpiride 13-fold as compared with noradrenaline in a control medium. We concluded that both drugs stimulated catecholamine secretion directly from the tumor and thus, careless administration of these drugs should be avoided when pheochromocytoma was suspected, large or small. Finally, the rate of tumor growth seemed to be very slow because it took 9 years to ach
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PMID:[Case of intrathoracic pheochromocytoma occurring 9 years after resection of intraabdominal paraaortic pheochromocytoma: effect of metoclopramide and sulpiride on catecholamine secretion in vitro]. 666 41

A 16 year-old male, who had marked hypertension and complained of palpitation, hyperhidrosis, headache and weight-loss, was diagnosed as atrial septal defect with pheochromocytoma. The first operation was performed for tumor on September 3, 1981. The hemodynamic change was recorded through the operation. The total systemic peripheral resistance and the total pulmonary resistance were improved after surgery. The systemic and pulmonary blood pressure were also decreased to normal level after surgery, although pulmonary arterial flow was increased. On one hundred and third day after this operation, radical correction for the cardiac malformation was performed. Operative and postoperative course were uneventful and the patient is free from all untoward complaints at this moment. Blood or urine catecholamine levels have also improved and are within normal limits.
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PMID:[A successfully operated case of atrial septal defect with pheochromocytoma]. 667 77

The authors report the case of a 10 year old child presenting with a three year history of paroxysmal headaches resembling migraine, and with a positive family history of the condition. It was only after three years that the symptomatology changed to become very suggestive of pheochromocytoma. The case illustrates the difficulties of assessing headaches in childhood and the authors question whether catecholamines and their metabolites should be measured in addition to the classical investigations (retinoscopy, skull X-Ray, EEG, CAT) in children with recurrent, severe and unexplained headaches. The importance of taking the blood pressure during an attack, a simple procedure which may be performed by parents, is emphasised.
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PMID:[Pheochromocytoma in children disclosed by pseudomigrainous headache attacks]. 670 69

The incidence of pheochromocytoma among the hypertensive population is less than 1%. One third of the patients have intermittent hypertension, one third have remittent hypertension, and one third have persistent hypertension. The most common symptoms accompanying paroxysms include palpitation, headache, sweating, and pallor. Several familial syndromes have been described and should be searched for in every case of pheochromocytoma. Indications for screening for this tumor include severe and progressive hypertension, labile hypertension, or paroxysmal, symptomatic hypertension. In the majority of cases, diagnosis can be established by urinary assays for vanillylmandelic acid (VMA) and metanephrine. Plasma catecholamine determinations and computerized axial tomography have added other dimensions to the preoperative diagnosis and localization of this tumor. Surgery is obviously the treatment of choice. Preoperative alpha-blockade ameliorates clinical manifestations, allows volume expansion, and allows safe induction of anethesia.
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PMID:Pheochromocytoma: clinical diagnosis and management. 703 87

Eight cases of pheochromocytoma in children were managed between 1958 and 1978. Headache, visual blurring, sweating, and hypertension were the most common findings. One patient presented with a hypertensive crisis during appendectomy. Three other children had a family history of pheochromocytoma and Hippel-Landau disease, thyroid carcinoma, and renal stones. The diagnostic approach was based on a high suspicion of the disease from the clinical picture. The most reliable laboratory investigations were urinary VMA, metanephrine, and catecholamines. I.V.P. and angiography were successful in localizing the tumor. In 4 cases, CT scan localized the tumor, although a second tumor was not seen in 1 case. Preoperative control of hypertension was achieved with phenoxybenzamine, propanolol, apresoline and reserpine in seven cases. The main anesthetic drugs used were pentothal, methoxyflurane, nitrous oxide, Innovar, and pancuronium. Tumors were located in the right adrenal in four, the left adrenal in two, both adrenals in one, and bilateral para-aortic sites in one. In two cases, hypertensive episodes during manipulation of the tumor were controlled with phentolamine. Ligation of the venous drainage from a tumor was associated with a sudden sustained fall in systemic blood pressure in six cases. In two, blood pressure remained elevated until a second tumor was found and removed. Hypotension was then corrected by the rapid infusion of fluid and blood, and vasopressors were not used. There were no postoperative complications and all children remained normotensive during the follow-up. The tumors of seven of the patients were benign. One tumor showed a low grade malignancy.
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PMID:Pheochromocytoma in children--an update. 741 63

This study presents the clinicopathologic findings in four new cases of adrenal medullary hyperplasia. The patients presented with episodic hypertension frequently associated with palpitations, headache, and diaphoresis. All four had elevated urinary catecholamine levels during attacks, and were thought clinically to have a pheochromocytoma. In each case laparotomy revealed a diffusely enlarged adrenal gland without a discrete tumor. Histologic examination of the adrenals demonstrated a diffuse and nodular expansion of the medulla confirmed by morphometric study. Of the four patients, three underwent unilateral and one bilateral adrenalectomy. Two patients who underwent unilateral adrenalectomy have been free of symptoms for three years. Thus, it would appear that adrenal medullary hyperplasia may occur unilaterally or asynchronously in the two glands. The bilaterally adrenalectomized patient has had persistent attacks, suggesting that the stimulus to adrenal medullary hyperplasia may possible affect other chromaffin tissues. On the basis of our cases and a review of the literature, we propose the following criteria for the diagnosis of adrenal medullary hyperplasia: a clinical history of episodic attacks suggesting pheochromocytoma (generally with associated increased urinary catecholamine levels), an adrenal gland showing diffuse expansion of the medulla into the alae or tail of the gland with or without nodule formation, a medulla composed of enlarged cells with or without pleomorphism, and, most important, an increased medulla/cortex ratio, together with an increased calculated medullary weight as determined by morphometric analysis.
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PMID:Adrenal medullary hyperplasia: a clinicopathologic study of four cases. 745 Jul 38


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