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Iwański MA, Sokołowska A, Sokołowski A, Wojdyła R, Styczkiewicz K. The Prevalence of Orthostatic Hypotension in Cancer Patients. Cancers (Basel) 2024; 16:1541. [PMID: 38672623 PMCID: PMC11049507 DOI: 10.3390/cancers16081541] [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: 03/17/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population. METHODS A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg. RESULTS The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m2. In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m2 and diabetes. CONCLUSIONS Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered.
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Affiliation(s)
- Mateusz A. Iwański
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
| | - Aldona Sokołowska
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
| | - Andrzej Sokołowski
- Collegium Humanum, Warsaw Management University, 133A Aleje Jerozolimskie St., 02-304 Warsaw, Poland;
| | - Roman Wojdyła
- New Medical Techniques Specialist Hospital of the Holy Family, Rudna Mała 600, 36-060 Rzeszow, Poland;
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Katarzyna Styczkiewicz
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
- Subcarpathian Oncological Centre, Frederic Chopin University Clinical Hospital, 2 Fryderyka Szopena St., 35-055 Rzeszow, Poland
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Zvizdic Z, Selimovic M, Mesic A, Anic D, Misanovic V, Skenderi F, Vranic S. Unexpected adrenal pheochromocytoma associated with a generalized tonic-clonic seizure in a prepubertal boy: A case report. Medicine (Baltimore) 2021; 100:e24303. [PMID: 33530220 PMCID: PMC7850757 DOI: 10.1097/md.0000000000024303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pheochromocytoma (PHEO) is a rare neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. Most pediatric PHEOs are functional tumors, and clinical manifestations are related to catecholamine hypersecretion and/or tumor mass effects. PATIENT CONCERNS We report here a case of a 10-year-old boy with a highly functional adrenal PHEO detected after the evaluation of a generalized tonic-clonic seizure in the patient. His vital signs at admission were: blood pressure up to 220/135 mm Hg; pulse, 112 beats/min; temperature, 37.4°C; respiratory rate, 22 breaths/min. DIAGNOSIS A 24-hour urine collection for catecholamines test showed a marked increase in Vanillylmandelic acid levels (338.9 μmol/L). An abdominal magnetic resonance imaging revealed a well-defined left adrenal gland mass measuring ∼5 cm in its largest dimension. INTERVENTIONS The mass was surgically removed, and histopathological examination revealed PHEO with low malignant potential (Adrenal Gland Scaled Score/PASS/ < 4). OUTCOMES The patient was discharged on the 10th postoperative day in good condition. At 24-month follow-up, the patient was doing well without complications such as tumor recurrence, elevated blood pressure, and seizure. LESSONS PHEO should be considered in the differential diagnosis of children with seizures presenting in the emergency department. A multidisciplinary approach to the evaluation and treatment of PHEO is also crucial for a successful outcome.
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Affiliation(s)
| | | | - Amira Mesic
- Department of Anesthesiology and Reanimation
| | | | | | - Faruk Skenderi
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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Affiliation(s)
- James K Moon
- Department of Surgery, The Mount Sinai Hospital, New York, NY
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia.
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Emms H, Farah G, Shine B, Boot C, Toole B, McFadden M, Lam L, Ou ZQ, Woollard G, Madhavaram H, Kyle C, Grossman AB. Falsely elevated plasma metanephrine in patients taking midodrine. Ann Clin Biochem 2018; 55:509-515. [DOI: 10.1177/0004563218755817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Plasma metanephrines have become the biochemical test of choice for suspected phaeochromocytomas and paragangliomas in many institutions. We encountered two separate cases of significantly elevated plasma metanephrines in patients taking midodrine, a sympathomimetic drug used in the treatment of severe postural hypotension, in the absence of a diagnosis of phaeochromocytomas and paragangliomas. Upon stopping midodrine treatment, plasma metanephrine concentrations returned to normal in both patients. To explore the hypothesis that midodrine or its metabolite desglymidodrine might interfere with the metanephrines assay, we tested the interaction of midodrine with metanephrine assays from two different centres. High-performance liquid chromatography tandem mass spectrometry on plasma samples and on methanolic extract of midodrine demonstrated co-elution of the metabolite desglymidodrine with metanephrine. We conclude that patients taking midodrine may have falsely elevated plasma metanephrine as a result of analytical interference, and clinicians need to be aware of this problem.
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Affiliation(s)
- Holly Emms
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - George Farah
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Chris Boot
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Barry Toole
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Martin McFadden
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Leo Lam
- Department of Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Zong-Quan Ou
- Department of Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Gerald Woollard
- Department of Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Hima Madhavaram
- Department of Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Campbell Kyle
- Department of Specialist Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Schiller D, Schöfl R, Bismut M, Danlos FX, Galland J, Gourguechon C, Lhote R, Peiffer-Smadja N. What else ? Dyspnée soudaine chez une femme de 45 ans. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2015.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alboni P, Coppola P, Stucci N, Tsakiridu V. Differential diagnosis between 'unexplained' fall and syncopal fall: a difficult or impossible task. J Cardiovasc Med (Hagerstown) 2014; 16:82-9. [PMID: 24838038 DOI: 10.2459/jcm.0000000000000076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Falls may be accidental (because of slipping, tripping or environmental hazards) or 'unexplained', when there is no apparent cause. Syncope is a transient loss of consciousness (LOC) and, if it occurs when the person is in the upright position, may lead to a fall. The differential diagnosis between 'unexplained' fall and syncopal fall can be difficult, if not impossible, because many patients have retrograde amnesia after syncope, that is they do not remember their prodromal symptoms. Based on the results of many randomized studies, the international guidelines on falls suggest multifactorial assessment and multifactorial treatment. Unfortunately, however, the vast majority of studies have been carried out on a mixed population of patients who have suffered accidental and 'unexplained' falls. As 'unexplained' falls account for a minority of cases, we really do not know the efficacy of multifactorial treatment in patients with this type of fall. Very recent data seem to prove that many older patients with 'unexplained' falls are actually affected by reflex syncope with retrograde amnesia, as they experience LOC during tilt testing or carotid sinus massage. Although these data make an important contribution to our knowledge of the mechanism of 'unexplained' falls, the therapeutic problems remain largely unsolved.
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Affiliation(s)
- Paolo Alboni
- aSection of Cardiology bDivision of Medicine, Ospedale Privato Quisisana, Ferrara, Italy
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Cecchi R, Frati P, Capri O, Cipolloni L. A rare case of sudden death due to hypotension during cesarean section in a woman suffering from pheochromocytoma and neurofibromatosis. J Forensic Sci 2013; 58:1636-9. [PMID: 24117722 DOI: 10.1111/1556-4029.12279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/12/2012] [Accepted: 12/01/2012] [Indexed: 11/29/2022]
Abstract
Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37-year-old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra-operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin-A (CgA), CD20 antibody (L26), anti-Keratocan antibody (KER-1) and neuron-specific enolase (NSE), and a PHEO-induced cardiomyopathy. The physiopathology of both stress-induced cardiomyopathy and PHEO-induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues.
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Affiliation(s)
- Rossana Cecchi
- Department of Anatomical Histological Legal Medical and Orthopaedic Sciences, Faculty of Medicine and Pharmacology, Sapienza University of Rome, Rome, Italy
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Vantyghem MC, Douillard C, Balavoine AS. Hypotensions d’origine endocrinienne. Presse Med 2012; 41:1137-50. [DOI: 10.1016/j.lpm.2012.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
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Coupe NA, Lacey J, Sanderson C. Unique manifestations of catecholamine release in malignant pheochromocytoma: an experience within an inpatient palliative care unit. J Pain Symptom Manage 2012; 43:967-72. [PMID: 22285283 DOI: 10.1016/j.jpainsymman.2011.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 05/17/2011] [Accepted: 05/28/2011] [Indexed: 11/19/2022]
Abstract
Malignant pheochromocytoma is a rare disorder. We describe the case of a 41-year-old female with disseminated metastatic pheochromocytoma who was admitted for ongoing palliative and supportive care within an inpatient palliative care unit. Predominant symptoms included severe gastrointestinal pseudo-obstruction and orthostatic hypotension Pseudo-obstruction management included percutaneous enterogastric and percutaneous enterojejunostomy tubes for gastric decompression and delivery of nutrition, respectively. Debilitating symptoms of orthostatic hypotension were mitigated with judicious fluid balance and appropriate use of adrenergic blocking agents. The potential for metoclopramide to worsen symptoms also was a significant component of management. The case presents rare features of this unusual disease and is unique for its setting within the confines of a palliative care unit.
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Roberton A, Ferro A. Metastatic paraganglioma: management of orthostatic hypotension - a case report. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012021. [PMID: 24175074 PMCID: PMC3738366 DOI: 10.1258/cvd.2012.012021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 11/18/2022] Open
Affiliation(s)
- Andrew Roberton
- Department of Clinical Pharmacology, King's College London and Guy's and St Thomas' NHS Foundation Trust , London , UK
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Peng CZ, Chen JD, How CK, Yen DHT, Huang MS. Catecholamine crisis due to spontaneous ruptured adrenal pheochromocytoma. J Cardiovasc Med (Hagerstown) 2011; 12:518-9. [PMID: 21558874 DOI: 10.2459/jcm.0b013e328346a6ea] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chian-Ze Peng
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan
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12
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Samuels MA, Pomerantz BJ, Sadow PM. Case records of the Massachusetts General Hospital. Case 14-2010. A 54-year-old woman with dizziness and falls. N Engl J Med 2010; 362:1815-23. [PMID: 20463342 DOI: 10.1056/nejmcpc0910070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Martin A Samuels
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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Abstract
ABSTRACT
The anesthetic management of pheochromocytoma is complicated and challenging. However, preoperative pharmacologic preparation has greatly improved perioperative outcome, and modern anesthetic drugs combined with advanced monitoring contribute to intraoperative stability. There is great regional and international variation in which intraoperative anesthetic technique is employed and there are little data to suggest one approach over another. Nevertheless, most management principles are universal. Progress lies in improved data collection that is increasingly available with electronic anesthesia information systems.
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