Tag Archives: pheochromocytoma

Does surgical treatment improve diabetes in pheochromocytoma patients? A comparative study before and after tumor resection in a series of 23 patients

DOI: 10.2478/amma-2025-0028

Objective: The present study aimed to assess the prevalence of diabetes in a cohort of pheochromocytoma patients registered at the Pathology Departments of two County Hospitals. Additionally, diabetes status was re-evaluated following tumor resection to determine whether surgery had an impact on improving or alleviating the condition.
Methods: We performed a retrospective study including all patients who underwent adrenalectomy and were diagnosed with pheochromocytoma based on histopathological findings in Mureș County (2017-2022) Hospital and Mureș County Emergency (2000-2022), Romania, respectively. All patients that were alive and whose contact details were available, participated in a phone survey and provided clinical data. Information on the presence of diabetes at the time of pheochromocytoma diagnosis and their diabetes status after tumor resection was recorded. The follow-up period ranged from 24 to 216 months.
Results: We identified 35 patients with a histopathological diagnosis of pheochromocytoma. Complete histopathological and clinical data were obtained for 23 patients; 13/23 (56.5%) were women and 10/23 (43.59%) were men; the mean age at surgery was 52.73 ±14.22 years-old (range 24-78). Of these, eight patients (n=8/23; 34.7%) were diagnosed with diabetes prior to surgery. All diabetic patients showed improvements in their carbohydrate metabolism and 5 (62.5%) of them revealed a restored normal glucose tolerance after surgery.
Conclusions: Our study highlights that overt diabetes mellitus is present in more than one-third of patients with pheochromocytoma. Tumor removal improves dysglycemia in all diabetic pheochromocytoma patients and cures diabetes in a significant proportion of them.

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Pharmacological management of intraoperative hypertensive crises in pheochromocytoma: A narrative review of esmolol, nicardipine, and sodium nitroprusside

DOI: 10.2478/amma-2025-0029

Management of pheochromocytoma, particularly in the perioperative period, requires a tailored pharmacological approach to address hemodynamic instability and hypertensive crises. This review evaluates the safety, efficacy, and clinical context of esmolol, nicardipine, and sodium nitroprusside in managing blood pressure and heart rate during pheochromocytoma resection. Esmolol, an ultra-short-acting β1-adrenergic antagonist, is essential in controlling tachyarrhythmias and myocardial stress in the perioperative period. Its rapid onset and short half-life enable precise titration, though continuous monitoring is required to mitigate the risk of bradycardia and hypotension. Nicardipine, a dihydropyridine calcium channel blocker, is effective in controlling acute hypertensive episodes and maintaining coronary perfusion. Its selectivity for vascular smooth muscle makes it an ideal agent for patients with low ejection fraction, minimizing cardiac depression. In contrast, sodium nitroprusside, a direct nitric oxide donor, provides immediate and reversible vasodilation, which is crucial for managing hypertensive crises during surgery. However, its use necessitates close monitoring due to the risk of cyanide and thiocyanate toxicity with prolonged use.
Choosing the most appropriate antihypertensive therapy depends on patient-specific factors such as comorbidities and the severity of hemodynamic changes. Each medication’s therapeutic effect, side effects, and risk profiles should be carefully considered to optimize clinical outcomes in high-risk patients undergoing pheochromocytoma surgery. This review highlights the importance of understanding the pharmacodynamics and appropriate use of these agents in clinical practice to improve patient management and outcomes.

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Unusual case of infrarenal pheochromocytoma developed on ectopic adrenal tissue: An autopsy case report

DOI: 10.2478/amma-2022-0025

Introduction: Pheochromocytomas are catecholamine-secreting tumors arising from the chromaffin cells of the adrenal medulla. We describe an unusual case of pheochromocytoma located in the infrarenal area and associated with bilateral adrenal hyperplasia.
Case presentation: A 70-year-old patient was admitted for syncope, diaphoresis, and high blood pressure. Computed tomography showed a 73x70x72 mm retroperitoneal mass of the left infrarenal area. High levels of metanephrine and noradrenaline were found in the urine. A tumor resection was performed. A few days after surgery, the blood pressure suddenly decreased and could not be restored, resulting in the death of the patient. Histopathological examination of the surgical specimen revealed a proliferation of monotonous cells, with eosinophilic cytoplasm, round nuclei with prominent nucleoli arranged in clusters, and capsular and vascular invasion. The tumor cells expressed synaptophysin and chromogranin, without positivity for inhibin A or S100 protein. At the autopsy, both adrenal glands showed hyperplasia but unrelated to the tumor mass. The histological aspect, location, and immunophenotype indicated an ectopic infrarenal pheochromocytoma.
Conclusions: In patients with pheochromocytoma developed on ectopic adrenal tissue, clinical management might be difficult, and diagnosis can be sometimes established only based on post-mortem histopathological examination. Autopsy can be extremely useful in such cases with unexplained evolution.

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