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Query: UMLS:C0031511 (pheochromocytoma)
 14,622 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.
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PMID:Pheochromocytoma with inferior vena cava thrombosis: An unusual association. 2262 39

Although laparoscopic adrenalectomy is well established for the treatment of adrenal pheochromocytomas, there is scant literature on a laparoscopic approach to extra-adrenal pheochromocytomas (EAP). We report on 2 patients with renal hilar pheochromocytomas treated by a laparoscopic resection. A 56-year-old hypertensive man was found to have a 3.5-cm tumor in the right renal hilum, which was confirmed to be a pheochromocytoma on the basis of elevated urinary vanillylmandelic acid levels and a positive 131I-MIBG scan. After pharmacological preparation, he underwent a laparoscopic excision. The recovery was uneventful and the final histopathology confirmed an EAP. The second patient, a 17-year-old hypertensive girl, was shown to have a 2.5-cm tumor in close proximity to the left renal vessels and a poorly functioning left kidney on a computed tomography scan. Subsequent isotope renogram showed 4% function in the left kidney. After adequate preparation, she underwent a laparoscopic left nephrectomy along with resection of the tumor. The postoperative period was uneventful. Histopathology showed an EAP. The kidney showed ischemic changes along with severe renal artery stenosis. The patients remain well 49 and 14 months post-surgery. In conclusion, careful preoperative preparation, expert intraoperative anesthetic management, and surgery performed by an experienced surgeon make laparoscopic resection of renal hilar pheochromocytomas a safe and feasible treatment option.
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PMID:Laparoscopic management of renal hilar pheochromocytomas. 2267 38

Pheochromocytoma and renal artery stenosis are two common causes of surgically correctable childhood hypertension that may coexist. We describe a case of extraadrenal pheochromocytoma with left upper polar renal artery pseudostenosis. The tumor was excised, preserving the accessory renal artery and kidney. The child was normotensive and did not require drugs postoperatively. Radiologic appearance of stenosis does not necessarily mean fixed renal artery stenosis, especially with a pheochromocytoma because it may exist as a result of vasospastic effects of the pheochromocytoma. Incorrect diagnosis may result in untoward risk and unnecessary procedures for the patient, hence the need to remember this pitfall.
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PMID:Extraadrenal pheochromocytoma with renal artery "pseudostenosis"-an important pitfall. 2290 22

Renal artery stenosis (RAS) often coexists with pheochromocytoma (Pheo)/paraganglioma (PGL) and often alters the management of patients with Pheo/PGL. We have studied the prevalence of RAS in our Pheo/PGL patients. The study included 70 consecutive, histopathologically proven Pheo/PGL patients from a tertiary health care center. In 60 patients, tumors were limited to adrenal glands (54 unilateral and 6 bilateral) while other 10 patients had extra-adrenal abdominal tumors. Five patients had RAS with an overall prevalence of 14%. Only two out of 60 patients with Pheo had RAS with a low prevalence of 3.3% while three out of 10 patients with extra-adrenal abdominal PGL had RAS with a prevalence of 30%. To conclude, RAS commonly coexists with Pheo/PGL, more often with extra-adrenal PGL.
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PMID:Coexistence of pheochromocytoma/praganglioma and renal artery stenosis. 2322 53

Resistant hypertension (RH) is defined as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a diuretic. The exact prevalence of resistant hypertension is unknown which may vary from 5% to 50%. Patient or clinician-related factors contributing to resistant hypertension include patient's non-adherence to antihypertensive therapy, White-coat effect and pseudo-hypertension and life style factors (Obesity, alcohol, smoking, dietary sodium etc). Several drugs may induce pre-existing hypertension where non-steroidal anti-inflammatory drugs are usually the most common due to their frequent use; whereas oral contraceptives, sympathomimetics (decongestants, anorectics), adrenal steroids and antineoplastic drugs targeting the vascular endothelial growth factor (VEGF) pathway has a good deal of contribution to resistant hypertension. Most common secondary causes of resistant hypertension are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushing's disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute to resistant hypertension. Both pharmacological and non-pharmacological treatments are available for the management of resistant hypertension. This article reviews the prevalence, symptoms, causes and treatment of resistant hypertension.
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PMID:Resistant hypertension: underlying causes and treatment. 2352 42

Hypertension is one of the major complications in neurofibromatosis type 1 (NF1). It is known to be caused by renal artery stenosis or pheochromocytoma. However, more than half of hypertensive patients with NF1 do not have either disorder. We report here on a 13-year-old male with NF1 who had hypertension and a stenosis of the right renal artery associated with elevated renal vein renin on the diseased side. He underwent percutaneous transluminal renal angioplasty. In spite of successful dilation of the artery and normalized renin level, high blood pressure persisted beyond 6 months requiring antihypertensive medication. His wide pulse pressure suggested arterial stiffness due to NF1 vasculopathy. We posit that the cause of hypertension in this patient was considered to be arterial stiffness ascribed to NF1 vasculopathy rather than renal artery stenosis. Increased pulse pressure supports the hypothesis. This marker of arterial stiffness can be assessed non-invasively and should be evaluated routinely in NF1.
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PMID:Persistent hypertension despite successful dilation of a stenotic renal artery in a boy with neurofibromatosis type 1. 2356 56

The coexistence of pheochromocytoma and renal artery stenosis had been reported occasionally from the possible mechanism of catecholoamine-induced vasospasm and extrinsic compression of renal artery in some reported cases. However, renal infarction caused by pheochromocytoma is an uncommon phenomenon. Herein, we report an interesting case of adrenal pheochromocytoma associated with renal artery thrombosis, which should be included in the differential diagnosis of pheochromocytoma patients who present with abdominal pain.
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PMID:Renal infarction associated with adrenal pheochromocytoma. 2387 89

Pheochromocytomas have been described in association with rare vascular abnormalities, most common of them being renal artery stenosis. A 45-year-old woman was admitted to our hospital with complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and severe hypertension. For the last several days, she was having a dull aching abdominal pain with a palpable, pulsatile, expansile and non-tender mass in the epigastric region. Hypertension was confirmed biochemically to result from excess catecholamine production. Abdominal computed tomography revealed the presence of a right adrenal pheochromocytoma. Magnetic resonance imaging of the abdomen demonstrated an abdominal aortic aneurysm (AAA) of maximum transverse diameter of 4.5 cm with 3 cm lumen. Surgical removal of pheochromocytoma resulted in normalization of blood pressure to normal. Because of the asymptomatic 4.5 cm aneurysm, our patient was advised for periodic follow-up. To our belief, this is the first such case report emanating from India, citing this rare association between pheochromocytoma and AAA. It is concluded that when the two diseases occur simultaneously, both must be diagnosed accurately and treated adequately. Possible mechanisms of such an uncommon association are also discussed.
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PMID:Coexistence of pheochromocytoma with abdominal aortic aneurysm: an untold association. 2391

Most patients with hypertension have essential hypertension or well-known forms of secondary hypertension, such as renal disease, renal artery stenosis, or common endocrine diseases (hyperaldosteronism or pheochromocytoma). Physicians are less aware of drug induced hypertension. A variety of therapeutic agents or chemical substances may increase blood pressure. When a patient with well controlled hypertension is presented with acute blood pressure elevation, use of drug or chemical substance which increases blood pressure should be suspected. Drug-induced blood pressure increases are usually minor and short-lived, although rare hypertensive emergencies associated with use of certain drugs have been reported. Careful evaluation of prescription and non-prescription medications is crucial in the evaluation of the hypertensive individual and may obviate the need for expensive and unnecessary evaluations. Discontinuation of the offending agent will usually achieve adequate blood pressure control. When use of a chemical agent which increases blood pressure is mandatory, anti-hypertensive therapy may facilitate continued use of this agent. We summarize the therapeutic agents or chemical substances that elevate blood pressure and their mechanisms of action.
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PMID:Drug induced hypertension--An unappreciated cause of secondary hypertension. 2609 56

Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.
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PMID:Secondary Hypertension: Discovering the Underlying Cause. 2909 13


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