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Mamilla D, Araque KA, Brofferio A, Gonzales MK, Sullivan JN, Nilubol N, Pacak K. Postoperative Management in Patients with Pheochromocytoma and Paraganglioma. Cancers (Basel) 2019; 11:cancers11070936. [PMID: 31277296 PMCID: PMC6678461 DOI: 10.3390/cancers11070936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 12/26/2022] Open
Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.
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Affiliation(s)
- Divya Mamilla
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Katherine A Araque
- Adult Endocrinology Department, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alessandra Brofferio
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melissa K Gonzales
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - James N Sullivan
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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Fu H, Sun K, Li J, Gong W, Agopian V, Yan M, Busuttil RW, Steadman RH, Xia VW. Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation. Clin Transplant 2018; 32:e13422. [PMID: 30312516 DOI: 10.1111/ctr.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/07/2018] [Accepted: 10/07/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Hong Fu
- Department of Anesthesiology; Chongqing Traditional Chinese Medicine Hospital; Chongqing China
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Kai Sun
- Department of Anesthesiology; Second Affiliated Hospital of Zhejiang University of School of Medicine; Hangzhou Zhejiang China
| | - Jun Li
- Department of Anesthesiology; Mianyang Central Hospital; Mianyang City Sichuan Province China
| | - Weiyi Gong
- Department of Anesthesiology; Baoan District People’s Hospital; Shenzhen China
| | - Vatche Agopian
- Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Min Yan
- Department of Anesthesiology; Second Affiliated Hospital of Zhejiang University of School of Medicine; Hangzhou Zhejiang China
| | - Ronald W. Busuttil
- Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Randolph H. Steadman
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Victor W. Xia
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
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Abstract
In the last 25 years, liver transplantation in children has become an effective, definitive, and universally accepted treatment for terminal liver diseases. Long-term survival exceeds 80% and improves each year as the result of constant technical advancements and improvements in immediate postoperative intensive care and clinical control.
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Affiliation(s)
- Uenis Tannuri
- Laboratory of Pediatric Surgery Research (LIM-30), Pediatric Surgery and Liver Transplantation Division, Medical School, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Cristina Aoun Tannuri
- Laboratory of Pediatric Surgery Research (LIM-30), Pediatric Surgery and Liver Transplantation Division, Medical School, University of Sao Paulo, Sao Paulo, SP, Brazil
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