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Yang Y, Zhou T, Zhao X, Cai Y, Xu Y, Gang X, Wang G. Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review. Medicine (Baltimore) 2024; 103:e37916. [PMID: 38669419 PMCID: PMC11049756 DOI: 10.1097/md.0000000000037916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.
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Affiliation(s)
- Yuqi Yang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Tong Zhou
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yunjia Cai
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yao Xu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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2
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King TFJ, Mok Y, Dacay LM, Wong HS, Hsu PP, Tan A, Wong KM, Saffari SE, Lenders JWM, Puar TH. Plasma Metanephrines Yield Fewer False-Positive Results Than Urine Metanephrines in Patients With Obstructive Sleep Apnea. J Clin Endocrinol Metab 2024; 109:844-851. [PMID: 37721483 DOI: 10.1210/clinem/dgad553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/08/2023] [Accepted: 09/16/2023] [Indexed: 09/19/2023]
Abstract
CONTEXT Obstructive sleep apnea (OSA) is associated with increased nocturnal sympathetic activity. In OSA patients, elevations in metanephrines may lead to false-positive tests when evaluating for pheochromocytoma or paraganglioma (PPGL). OBJECTIVE To evaluate whether morning plasma metanephrines would lead to fewer false-positive results than 24-hour urinary metanephrines in OSA patients. METHODS Patients undergoing polysomnography for suspected OSA were recruited. Plasma free and 24-hour urinary metanephrines were measured by HPLC-MS/MS. Patients with elevated levels had repeat measurements, abdominal imaging, and follow-up to diagnose or exclude a PPGL. RESULTS Seventy-six patients completed polysomnography and biochemical testing; 68 (89.5%) patients had OSA, of whom 19 (27.9%) had elevated plasma and/or urinary metanephrines. On follow-up, one patient had a bladder paraganglioma, while PPGL was excluded in the remaining patients. OSA patients had more false-positive urinary metanephrines (17 of 67, 25.4%) than plasma metanephrines (2 of 67, 3.0%), P < .01, and this was more common in severe OSA (13 of 34, 38.2%), compared to moderate/mild OSA (4 of 33, 12.1%), P < .01. Both plasma and urinary metanephrines decreased after treatment with continuous positive airway pressure. On multivariable analysis, severe OSA, obesity, and family history of hypertension were positive predictors for false-positive urinary metanephrines in patients with suspected OSA. CONCLUSION In OSA patients, plasma metanephrines are less likely to yield false-positive results for the diagnosis of PPGL than 24-hour urinary metanephrines. In patients with suspected OSA, obesity, or a family history of hypertension, plasma metanephrines may be the preferred first-line test to avoid unnecessary anxiety or follow-up.
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Affiliation(s)
- Thomas F J King
- Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore
| | - Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore 529889, Singapore
- Department of Sleep Medicine, Surgery and Science, Changi General Hospital, Singapore 529889, Singapore
| | - Lily Mae Dacay
- Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore
| | - Hang Siang Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore 529889, Singapore
- Department of Sleep Medicine, Surgery and Science, Changi General Hospital, Singapore 529889, Singapore
| | - Pon Poh Hsu
- Department of Otorhinolaryngology, Changi General Hospital, Singapore 529889, Singapore
| | - Alvin Tan
- Department of Otorhinolaryngology, Changi General Hospital, Singapore 529889, Singapore
| | - Kang Min Wong
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Seyed Ehsan Saffari
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Troy H Puar
- Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore
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3
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Zeng L, Herdman DS, Lee SM, Tao A, Das M, Bertin S, Eckmann L, Mahata SK, Wu P, Hara M, Byun JW, Devulapalli S, Patel HH, Molina AJ, Osborn O, Corr M, Raz E, Webster NJ. Loss of cAMP Signaling in CD11c Immune Cells Protects Against Diet-Induced Obesity. Diabetes 2023; 72:1235-1250. [PMID: 37257047 PMCID: PMC10451016 DOI: 10.2337/db22-1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
In obesity, CD11c+ innate immune cells are recruited to adipose tissue and create an inflammatory state that causes both insulin and catecholamine resistance. We found that ablation of Gnas, the gene that encodes Gαs, in CD11c expressing cells protects mice from obesity, glucose intolerance, and insulin resistance. Transplantation studies showed that the lean phenotype was conferred by bone marrow-derived cells and did not require adaptive immunity. Loss of cAMP signaling was associated with increased adipose tissue norepinephrine and cAMP signaling, and prevention of catecholamine resistance. The adipose tissue had reduced expression of catecholamine transport and degradation enzymes, suggesting that the elevated norepinephrine resulted from decreased catabolism. Collectively, our results identified an important role for cAMP signaling in CD11c+ innate immune cells in whole-body metabolism by controlling norepinephrine levels in white adipose tissue, modulating catecholamine-induced lipolysis and increasing thermogenesis, which, together, created a lean phenotype. ARTICLE HIGHLIGHTS We undertook this study to understand how immune cells communicate with adipocytes, specifically, whether cAMP signaling in the immune cell and the adipocyte are connected. We identified a reciprocal interaction between CD11c+ innate immune cells and adipocytes in which high cAMP signaling in the immune cell compartment induces low cAMP signaling in adipocytes and vice versa. This interaction regulates lipolysis in adipocytes and inflammation in immune cells, resulting in either a lean, obesity-resistant, and insulin-sensitive phenotype, or an obese, insulin-resistant phenotype.
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Affiliation(s)
- Liping Zeng
- The Second Affiliated Hospital of Guangzhou Medical University, The State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, Guangzhou Medical University, China
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - D. Scott Herdman
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Sung Min Lee
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Ailin Tao
- The Second Affiliated Hospital of Guangzhou Medical University, The State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, Guangzhou Medical University, China
| | - Manasi Das
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Samuel Bertin
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Lars Eckmann
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Sushil K. Mahata
- Department of Medicine, University of California San Diego, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Panyisha Wu
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Miki Hara
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Ji-Won Byun
- Department of Dermatology, Inha University Hospital, Incheon, South Korea
| | - Shwetha Devulapalli
- Department of Anesthesiology, University of California San Diego, La Jolla, CA
| | - Hemal H. Patel
- VA San Diego Healthcare System, San Diego, CA
- Department of Anesthesiology, University of California San Diego, La Jolla, CA
| | | | - Olivia Osborn
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Maripat Corr
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Eyal Raz
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Nicholas J.G. Webster
- Department of Medicine, University of California San Diego, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
- Moores Cancer Center, University of California San Diego, La Jolla CA
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4
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Pang Y, Li M, Jiang J, Chen X, Fu Y, Wang C, He Y, Zhao Y, Wang Y, Guan X, Zhang L, Xu X, Gan Y, Liu Y, Xie Y, Tang T, Wang J, Xie B, Liang Z, Chen D, Liu H, Chen C, Eisenhofer G, Liu L, Yi X, Chen BT. Impact of body composition and genotype on haemodynamics during surgery for pheochromocytoma and paraganglioma. J Cachexia Sarcopenia Muscle 2022; 13:2843-2853. [PMID: 36068986 PMCID: PMC9745493 DOI: 10.1002/jcsm.13071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maintaining intraoperative haemodynamic stability can reduce cardiovascular complications during surgery for pheochromocytoma and paraganglioma (PPGL). Risk factors such as tumour size and catecholamine levels are reported to predict haemodynamic responses during surgery for PPGL. We hypothesized that additional factors including body composition and genetic information could further improve prediction. METHODS Consecutive patients with PPGL confirmed by surgical pathology between June 2010 and June 2019 were retrospectively included. Cross-sectional computed tomography images at the L3 level were used to assess body composition parameters including skeletal muscle area and visceral fat area. Next-generation sequencing was performed using a panel containing susceptibility genes of PPGL. Differences in clinical-genetic characteristics and body composition parameters were analysed and compared in patients with and without intraoperative haemodynamic instability (HDI). RESULTS We included 221 patients with PPGL (median age 47 [38-56] years, and 52% male). Among them, 49.8% had Cluster 2 mutations (related to kinase signalling pathways), 44.8% had sarcopenia, and 52.9% experienced intraoperative HDI. Compared with patients without HDI, more patients with HDI had Cluster 2 mutations (59.8% vs. 38.5%, P = 0.002) and less had sarcopenia (35.9% vs. 54.8%, P = 0.005). Multivariate analysis showed that urine vanillylmandelic acid ≥ 58 μmol/day (adjusted odds ratio [OR] = 1.840, 95% confidence interval [CI] = 1.012-3.347, P = 0.046), tumour size ≥ 4 cm (adjusted OR = 2.278, 95% CI = 1.242-4.180, P = 0.008), and Cluster 2 mutations (adjusted OR = 2.199, 95% CI = 1.128-4.285, P = 0.021) were independent risk factors for intraoperative HDI, while sarcopenia (adjusted OR = 0.475, 95% CI = 0.266-0.846, P = 0.012) decreased the risk. CONCLUSIONS Body composition and genotype were associated with intraoperative haemodynamics in patients with PPGL. Our results indicated that inclusion of body composition and genotype in the overall assessment of patients with PPGL helped to predict HDI during surgery, which could assist in implementing preoperative and intraoperative measures to reduce perioperative complications.
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Affiliation(s)
- Yingxian Pang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Minghao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.,Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Cikui Wang
- Department of Urology, Hubei Armed Police Corps Hospital, Wuchang, P. R. China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yuanzhe Zhao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yong Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Xiao Guan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Liang Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Xiaowen Xu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yalin Liu
- Xiangya School of Medicine, Central South University, Changsha, Hunan, P. R. China
| | - Yaoling Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Tingyuan Tang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Jing Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Zhihao Liang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Danlei Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Haipeng Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Changyong Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Xiaoping Yi
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.,Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, P. R. China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, P. R. China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Central South University, Changsha, Hunan, P. R. China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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Pacak K. New Biology of Pheochromocytoma and Paraganglioma. Endocr Pract 2022; 28:1253-1269. [PMID: 36150627 PMCID: PMC9982632 DOI: 10.1016/j.eprac.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Abstract
Pheochromocytomas and paragangliomas continue to be defined by significant morbidity and mortality despite their several recent advances in diagnosis, localization, and management. These adverse outcomes are largely related to mass effect as well as catecholamine-induced hypertension, tachyarrhythmias and consequent target organ damage, acute coronary syndromes, and strokes (ischemic and hemorrhagic stroke). Thus, a proper understanding of the physiology and pathophysiology of these tumors and recent advances are essential to affording optimal care. These major developments largely include a redefinition of metastatic behavior, a novel clinical categorization of these tumors into 3 genetic clusters, and an enhanced understanding of catecholamine metabolism and consequent specific biochemical phenotypes. Current advances in imaging of these tumors are shifting the paradigm from poorly specific anatomical modalities to more precise characterization of these tumors using the advent and development of functional imaging modalities. Furthermore, recent advances have revealed new molecular events in these tumors that are linked to their genetic landscape and, therefore, provide new therapeutic platforms. A few of these prospective therapies translated into new clinical trials, especially for patients with metastatic or inoperable tumors. Finally, outcomes are ever-improving as patients are cared for at centers with cumulative experience and well-established multidisciplinary tumor boards. In parallel, these centers have supported national and international collaborative efforts and worldwide clinical trials. These concerted efforts have led to improved guidelines collaboratively developed by healthcare professionals with a growing expertise in these tumors and consequently improving detection, prevention, and identification of genetic susceptibility genes in these patients.
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Affiliation(s)
- Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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6
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Main AM, Benndorf G, Feldt-Rasmussen U, Fugleholm K, Kistorp T, Loya AC, Poulsgaard L, Rasmussen ÅK, Rossing M, Sølling C, Klose MC. Case Report: Giant Paraganglioma of the Skull Base With Two Somatic Mutations in SDHB and PTEN Genes. Front Endocrinol (Lausanne) 2022; 13:857504. [PMID: 35498434 PMCID: PMC9044027 DOI: 10.3389/fendo.2022.857504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Head and neck paragangliomas (HNPGLs) are neuroendocrine tumors. They arise from the parasympathetic ganglia and can be either sporadic or due to hereditary syndromes (up to 40%). Most HNPGLs do not produce significant amounts of catecholamines. We report a case of a giant paraganglioma of the skull base with an unusually severe presentation secondary to excessive release of norepinephrine, with a good outcome considering the severity of disease. A 39-year-old Caucasian woman with no prior medical history was found unconscious and emaciated in her home. In the intensive care unit (ICU) the patient was treated for multi-organ failure with multiple complications and difficulties in stabilizing her blood pressure with values up to 246/146 mmHg. She was hospitalized in the ICU for 72 days and on the 31st day clinical assessment revealed jugular foramen syndrome and paralysis of the right n. facialis. A brain MRI confirmed a right-sided tumor of the skull base of 93.553 cm3. Blood tests showed high amounts of normetanephrine (35.1-45.4 nmol/L, ref <1.09 nmol/L) and a tumor biopsy confirmed the diagnosis of a paraganglioma. Phenoxybenzamine and Labetalol were used in high doses ((Dibenyline®, 90 mg x 3 daily) and labetalol (Trandate®, 200 + 300 + 300 mg daily) to stabilize blood pressure. The patient underwent two tumor embolization procedures before total tumor resection on day 243. Normetanephrine and blood pressure normalized after surgery (0.77 nmol/L, ref: < 1.09 nmol/L). The damage to the cranial nerve was permanent. Our patient was comprehensively examined for germline predisposition to PPGLs, however we did not identify any causal aberrations. A somatic deletion and loss of heterozygosity (LOH) of the short arm (p) of chromosome 1 (including SDHB) and p of chromosome 11 was found. Analysis showed an SDHB (c.565T>G, p.C189G) and PTEN (c.834C>G, p.F278L) missense mutation in tumor DNA. The patient made a remarkable recovery except for neurological deficits after intensive multidisciplinary treatment and rehabilitation. This case demonstrates the necessity for an early tertiary center approach with a multidisciplinary expert team and highlights the efficacy of the correct treatment with alpha-blockade.
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Affiliation(s)
- Ailsa Maria Main
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Götz Benndorf
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Kistorp
- Department of Anaesthesiology, Copenhagen University, Copenhagen, Denmark
| | - Anand C. Loya
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Christine Sølling
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Christina Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- *Correspondence: Marianne Christina Klose,
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7
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Krumeich LN, Cucchiara AJ, Nathanson KL, Kelz RR, Fishbein L, Fraker DL, Roses RE, Cohen DL, Wachtel H. Correlation Between Plasma Catecholamines, Weight, and Diabetes in Pheochromocytoma and Paraganglioma. J Clin Endocrinol Metab 2021; 106:e4028-e4038. [PMID: 34089611 PMCID: PMC8475214 DOI: 10.1210/clinem/dgab401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 01/22/2023]
Abstract
CONTEXT Pheochromocytomas and paragangliomas (PCC/PGL) are neuroendocrine tumors with discrete catecholamine profiles that cause incompletely understood metabolic and physiologic changes. OBJECTIVE The objective was to evaluate relationships between plasma catecholamines, body weight, and hemoglobin A1c (HbA1c). We hypothesized that individual catecholamines would correlate negatively with weight and glucose control. DESIGN A retrospective cohort study was performed (1999-2020). Wilcoxon rank-sum tests compared nonparametric, continuous variables; mixed-effect linear modeling (MEM) evaluated relationships between catecholamines and weight or HbA1c. The median study duration was 54.2 months [interquartile range (IQR) 19.0-95.1]. SETTING Tertiary academic hospital. PATIENTS 360 patients were identified prospectively by referral to our center for management or surveillance of PCC/PGL. The median age was 59 years (IQR 45-67) and 56.4% (n = 203) were female. MAIN OUTCOME MEASURES The primary and secondary outcomes were weight and HbA1c, respectively. RESULTS On multivariable MEM, norepinephrine (P < 0.0005) negatively correlated with weight when all catecholamines and their derivatives were tried in the model, and normetanephrine (P < 0.0005) correlated when only metanephrines were included. In the surgical cohort (n = 272), normetanephrine decreased postoperatively and was inversely associated with weight (P < 0.0005). Elevated norepinephrine or normetanephrine at the study termination, indicative of metastatic and/or recurrent disease (MRD), correlated with weight loss. Norepinephrine and normetanephrine (P < 0.0005) directly correlated with HbA1c. CONCLUSION Plasma norepinephrine and its metabolite directly correlate with HbA1c and inversely correlate with weight in PCC/PGL. After resection, declining normetanephrine levels correlate with improving HbA1c despite an increase in patient body weight. Persistently elevated catecholamines and decreasing weight are observed in MRD.
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Affiliation(s)
- Lauren N Krumeich
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Correspondence: Lauren Krumeich, MD MS, University of Pennsylvania, 3400 Spruce Street, 4 Maloney Pavilion, Philadelphia, PA 19104, USA.
| | - Andrew J Cucchiara
- Hospital of the University of Pennsylvania, Department of Biostatistics, Philadelphia, PA, USA
| | - Katherine L Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Rachel R Kelz
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Fishbein
- University of Colorado School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Diabetes and the Division of Biomedical Informatics and Personalized Medicine, Aurora, CO, USA
| | - Douglas L Fraker
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Roses
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Department of Medicine, Division of Renal, Electrolytes and Hypertension, Philadelphia, PA, USA
| | - Heather Wachtel
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Robeva R, Nedyalkova M, Kirilov G, Elenkova A, Zacharieva S, Kudłak B, Jatkowska N, Simeonov V. Multivariate Statistical Approach for Nephrines in Women with Obesity. Molecules 2021; 26:molecules26051393. [PMID: 33807567 PMCID: PMC7961883 DOI: 10.3390/molecules26051393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 12/22/2022] Open
Abstract
Catecholamines are physiological regulators of carbohydrate and lipid metabolism during stress, but their chronic influence on metabolic changes in obese patients is still not clarified. The present study aimed to establish the associations between the catecholamine metabolites and metabolic syndrome (MS) components in obese women as well as to reveal the possible hidden subgroups of patients through hierarchical cluster analysis and principal component analysis. The 24-h urine excretion of metanephrine and normetanephrine was investigated in 150 obese women (54 non diabetic without MS, 70 non-diabetic with MS and 26 with type 2 diabetes). The interrelations between carbohydrate disturbances, metabolic syndrome components and stress response hormones were studied. Exploratory data analysis was used to determine different patterns of similarities among the patients. Normetanephrine concentrations were significantly increased in postmenopausal patients and in women with morbid obesity, type 2 diabetes, and hypertension but not with prediabetes. Both metanephrine and normetanephrine levels were positively associated with glucose concentrations one hour after glucose load irrespectively of the insulin levels. The exploratory data analysis showed different risk subgroups among the investigated obese women. The development of predictive tools that include not only traditional metabolic risk factors, but also markers of stress response systems might help for specific risk estimation in obesity patients.
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Affiliation(s)
- Ralitsa Robeva
- Department of Endocrinology, Faculty of Medicine, Medical University—Sofia, USHATE “Acad. Iv. Penchev”, 2, Zdrave Str., 1431 Sofia, Bulgaria; (R.R.); (G.K.); (A.E.); (S.Z.)
| | - Miroslava Nedyalkova
- Department of Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, Bulgaria
- Correspondence:
| | - Georgi Kirilov
- Department of Endocrinology, Faculty of Medicine, Medical University—Sofia, USHATE “Acad. Iv. Penchev”, 2, Zdrave Str., 1431 Sofia, Bulgaria; (R.R.); (G.K.); (A.E.); (S.Z.)
| | - Atanaska Elenkova
- Department of Endocrinology, Faculty of Medicine, Medical University—Sofia, USHATE “Acad. Iv. Penchev”, 2, Zdrave Str., 1431 Sofia, Bulgaria; (R.R.); (G.K.); (A.E.); (S.Z.)
| | - Sabina Zacharieva
- Department of Endocrinology, Faculty of Medicine, Medical University—Sofia, USHATE “Acad. Iv. Penchev”, 2, Zdrave Str., 1431 Sofia, Bulgaria; (R.R.); (G.K.); (A.E.); (S.Z.)
| | - Błażej Kudłak
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 Narutowicza, 80-233 Gdańsk, Poland; (B.K.); (N.J.)
| | - Natalia Jatkowska
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, 11/12 Narutowicza, 80-233 Gdańsk, Poland; (B.K.); (N.J.)
| | - Vasil Simeonov
- Department of Analytical Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, Bulgaria;
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9
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Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T, Mannelli M, Deutschbein T, Timmers HJLM, Castinetti F, Dralle H, Widimský J, Gimenez-Roqueplo AP, Eisenhofer G. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens 2020; 38:1443-1456. [PMID: 32412940 PMCID: PMC7486815 DOI: 10.1097/hjh.0000000000002438] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: Phaeochromocytoma and paraganglioma (PPGL) are chromaffin cell tumours that require timely diagnosis because of their potentially serious cardiovascular and sometimes life- threatening sequelae. Tremendous progress in biochemical testing, imaging, genetics and pathophysiological understanding of the tumours has far-reaching implications for physicians dealing with hypertension and more importantly affected patients. Because hypertension is a classical clinical clue for PPGL, physicians involved in hypertension care are those who are often the first to consider this diagnosis. However, there have been profound changes in how PPGLs are discovered; this is often now based on incidental findings of adrenal or other masses during imaging and increasingly during surveillance based on rapidly emerging new hereditary causes of PPGL. We therefore address the relevant genetic causes of PPGLs and outline how genetic testing can be incorporated within clinical care. In addition to conventional imaging (computed tomography, MRI), new functional imaging approaches are evaluated. The novel knowledge of genotype-phenotype relationships, linking distinct genetic causes of disease to clinical behaviour and biochemical phenotype, provides the rationale for patient-tailored strategies for diagnosis, follow-up and surveillance. Most appropriate preoperative evaluation and preparation of patients are reviewed, as is minimally invasive surgery. Finally, we discuss risk factors for developing metastatic disease and how they may facilitate personalised follow-up. Experts from the European Society of Hypertension have prepared this position document that summarizes the current knowledge in epidemiology, genetics, diagnosis, treatment and surveillance of PPGL.
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Affiliation(s)
- Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laurence Amar
- Unité d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris-PARCC, INSERM, Paris, France
| | | | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - David Taieb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Joakim Crona
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomáš Zelinka
- Center for Hypertension, 3rd Department of Medicine, Division of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederic Castinetti
- Aix-Marseille Université, Department of Endocrinology, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), et Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Jřri Widimský
- Center for Hypertension, 3rd Department of Medicine, Division of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Anne-Paule Gimenez-Roqueplo
- Assistance Publique-Hôpitaux de Paris, AP-HP, Hôpital Européen Georges Pompidou, Service de Génétique, Université de Paris, PARCC, INSERM, Paris, France
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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10
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Kong H, Li N, Tian J, Li XY. Risk Predictors of Prolonged Hypotension After Open Surgery for Pheochromocytomas and Paragangliomas. World J Surg 2020; 44:3786-3794. [PMID: 32691105 DOI: 10.1007/s00268-020-05706-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prolonged hypotension is a common complication after surgery for pheochromocytomas and paragangliomas (PPGLs). It places patients at an increased risk of major morbidities and even death. The objective of the study was to investigate the risk predictors of prolonged hypotension in patients undergoing open surgery for PPGLs. METHODS The present study adopted a retrospective, single-center design. Patients who underwent open surgery for PPGLs were enrolled from January 1, 2002, to December 31, 2018, at Peking University First Hospital. Perioperative variables were screened from patients' electronic medical records. Prolonged hypotension was defined as hypotension that required continuous catecholamine support for at least 30 min to maintain a systolic blood pressure of > 90 mmHg after surgery. RESULTS A total of 162 patients were included in the study. Fifty-two patients (31.1%) had prolonged hypotension with a median vasopressor support duration of 14 h (IQR = 4-30 h). Body mass index <24 kg/m2 (OR = 3.015, 95% CI 1.217-7.467; P = 0.017), larger tumor size (OR = 1.146, 95% CI 1.014-1.295; P = 0.029), and higher plasma norepinephrine concentration (OR = 1.053, 95% CI 1.019-1.087; P = 0.002) were associated with prolonged hypotension. Patients with prolonged hypotension had a higher incidence of complication, were more frequently admitted to the intensive care unit, underwent mechanical ventilation for a longer duration, and had a longer postoperative hospital stay when compared to those without. CONCLUSION Body mass index < 24 kg/m2, larger tumor size, and higher plasma norepinephrine concentration are independent risk predictors of prolonged hypotension in patients undergoing open surgery for PPGLs.
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Affiliation(s)
- Hao Kong
- Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
| | - Nan Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Jie Tian
- Department of Urology, Peking University First Hospital, Beijing, 100034, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, 100034, China
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