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Lavalle-Martínez J, Suárez-Montalvo M. [Pheochromocytoma in multiple endocrine neoplasia 2A associated with pulmonary tuberculosis presenting as abdominal pain: a case report and literature review]. Medwave 2018; 18:e7320. [PMID: 30451214 DOI: 10.5867/medwave.2018.07.7320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/05/2018] [Indexed: 11/27/2022] Open
Abstract
Pheochromocytoma is a catecholamine-producing neoplasm that may occur sporadically or associated with hereditary diseases, such as multiple endocrine neoplasia. The classic symptoms are headache, sweating, and palpitations and are attributed to the sympathetic nervous system activity, usually presenting as paroxysms. On the other hand, pulmonary tuberculosis is an infectious disease considered a public health problem in many countries, whose incidence depends on risk factors such as immunosuppression. It is well known that endocrine-tumor diseases such as multiple endocrine neoplasia can predispose to chronic inflammation and immunosuppression. We report the case of a 38-year-old male patient who had an episode of arterial hypertension and abdominal pain as the first symptoms of a pheochromocytoma associated with multiple endocrine neoplasia type 2A. The patient developed pulmonary tuberculosis simultaneously, but we managed to treat both entities and achieve a favorable clinical course.
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Affiliation(s)
- José Lavalle-Martínez
- Departamento de Emergencias del Adulto, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. Address: Jirón Edgardo Rebagliati 490, Distrito de Jesús María, Ciudad de Lima, Perú.
| | - Mario Suárez-Montalvo
- Departamento de Medicina Interna, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Tsang VHM, Tacon LJ, Learoyd DL, Robinson BG. Pheochromocytomas in Multiple Endocrine Neoplasia Type 2. Recent Results Cancer Res 2015; 204:157-78. [PMID: 26494388 DOI: 10.1007/978-3-319-22542-5_7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pheochromocytoma (PC) is a neuroendocrine tumor that originates from chromaffin cells of the adrenal medulla. The production of catecholamines, including epinephrine, norepinephrine and dopamine, may lead to haemodynamic instability. Over 30% of PCs are associated with germline mutations, including re-arranged in transfection (RET) mutations seen in multiple endocrine neoplasia type 2 (MEN2) syndromes. Around 40% of individuals with MEN2 develop PC, though it is rarely the presenting feature. Compared to sporadic PC, MEN2-associated PC is more likely to be epinephine secreting and demonstrate bilateral adrenal involvement, and is less likely to be malignant. The diagnosis of PC requires clinical suspicion and biochemical testing, followed by imaging studies. Novel nuclear medicine modalities, including FDG positron emission tomography (PET) and 68Ga DOTATATE PET have added to the conventional techniques of 123I-metaiodobenzylguanindine (MIBG) scintigraphy, computer tomography and magnetic resonance imaging. Treatment of PC is surgical and requires peri-operative alpha and, frequently, beta blockade. Novel surgical techniques, such as adrenal sparing surgery and a laparoscopic approach, have decreased peri-operative morbidity. Surveillance for PC is life long, due to the risk of metastatic disease.
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Affiliation(s)
- Venessa H M Tsang
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Endocrinology, Acute Services Building, Clinic 1, Royal North Shore Hospital, St. Leonards, Sydney, NSW, 2065, Australia.
| | - Lyndal J Tacon
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Endocrinology, Acute Services Building, Clinic 1, Royal North Shore Hospital, St. Leonards, Sydney, NSW, 2065, Australia
| | - Diana L Learoyd
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Endocrinology, Acute Services Building, Clinic 1, Royal North Shore Hospital, St. Leonards, Sydney, NSW, 2065, Australia
| | - Bruce G Robinson
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Endocrinology, Acute Services Building, Clinic 1, Royal North Shore Hospital, St. Leonards, Sydney, NSW, 2065, Australia
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Brouwers FM, Eisenhofer G, Lenders JWM, Pacak K. Emergencies caused by pheochromocytoma, neuroblastoma, or ganglioneuroma. Endocrinol Metab Clin North Am 2006; 35:699-724, viii. [PMID: 17127142 DOI: 10.1016/j.ecl.2006.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pheochromocytoma may lead to important emergency situations, ranging from cardiovascular emergencies to acute abdomen and multiorgan failure. It is vital to think about this disease in any emergency situation when conventional therapy fails to achieve control or symptoms occur that do not fit the initial diagnosis. The importance of keeping this diagnosis in minds is underscored by the fact that, in 50% of pheochromocytoma patients, the diagnosis is initially overlooked. Two other tumors of the sympathetic nervous system, neuroblastoma and ganglioneuroma, are less commonly associated with emergency conditions. If they occur, they are often linked to catecholamine excess, paraneoplastic phenomena, or local tumor mass effect.
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Affiliation(s)
- Frederieke M Brouwers
- Section on Medical Neuroendocrinology, Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892-1109, USA
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Gosnell JE, Sywak MS, Sidhu SB, Gough IR, Learoyd DL, Robinson BG, Delbridge LW. NEW ERA: PROPHYLACTIC SURGERY FOR PATIENTS WITH MULTIPLE ENDOCRINE NEOPLASIA-2A. ANZ J Surg 2006; 76:586-90. [PMID: 16813623 DOI: 10.1111/j.1445-2197.2006.03783.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The surgical management of patients with multiple endocrine neoplasia-2A (MEN-2A) continues to evolve with specific genotype-phenotype correlations allowing for a more tailored approach. In this study, we report the surgical management of one of the largest MEN-2A families with a rearranged during transfection (RET) codon 804 mutation. METHOD This is a cohort study comprising all at-risk kindred within a single known MEN-2A family. Prophylactic total thyroidectomy with lymph node dissection was recommended to all mutation carriers aged 5 years and older. RESULTS There were a total of 48 at-risk individuals in the MEN-2A kindred, with 22 patients undergoing thyroidectomy after appropriate preoperative evaluation. A total of 9 patients had medullary thyroid cancer including 5 with a normal preoperative calcitonin level. A total of 11 patients had C-cell hyperplasia and 7 showed histological evidence of parathyroid disease. Only the index case had a phaeochromocytoma. CONCLUSIONS Genetic testing for germline mutations in the RET proto-oncogene has allowed precise identification of affected RET carriers and provided the opportunity for prophylactic or 'preclinical' surgery to treat and in fact to prevent medullary thyroid cancer. This concept of prophylactic surgery based on a genetic test is likely to be applied more widely as the tools of molecular biology advance.
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Affiliation(s)
- Jessica E Gosnell
- University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia
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