| Implicaciones y consideraciones durante la resección de feocromocitomas: Un reto para el anestesista |
Implications and considerations during pheochromocytoma resection: A challenge to the anesthesiologist
SukhminderJit Singh Bajwa and Sukhwinder Kaur Bajwa1
Indian J Endocrinol Metab. 2011 October; 15(Suppl4): S337-S344.
doi: 10.4103/2230-8210.86977
Abstract
Pheochromocytoma is a rare catecholamine secreting tumor arising commonly from adrenal medulla. It has got multidimensional challenging aspects in spite of our improved understanding of its physiological and clinical behavior during surgical resection. This neuroendocrine tumor is associated with a most unpredictable and fluctuating clinical course during anesthesia and surgical intervention. The clinical difficulties and challenges increase manifold in patients with undiagnosed or accidental diagnosis of pheochromocytoma who present to the hospital for the treatment of some other disease or emergency. The most common manifestations of this clinical spectrum include hypertension, headache, palpitations, episodic sweating, and feeling of doom. The definite and only treatment for this rare tumor is surgical resection which itself is very challenging for an anesthesiologist. This article reviews the pre-operative evaluation, pharmacological preparation, intraoperative and post-operative management of patients with pheochromocytoma especially from anesthesiologist's perspectives.
çKeywords: Beta-blockers, catecholamines, epinephrine, hypertension, magnesium sulphate, nor-epinephrine, phenoxybenzamine, pheochromocytoma
Bajwa
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| Manejo médico del feocromocitoma: Papel del endocrinólogo |
Medical management of pheochromocytoma: Role of the endocrinologist.
Garg M K, Kharb S, Brar K S, Gundgurthi A, Mittal R.
Indian J Endocr Metab [serial online] 2011 [cited 2013 Apr 6];15:329-36.
Abstract
Pheochromocytoma is a rare tumor arising from chromaffin cells in adrenal medulla or other paraganglia in the body. Pheochromocytomas cause increased catecholamine production leading to its clinical manifestations. Pheochromocytoma derives its name from phaios (dusky), chroma (color), cytoma (tumor). The term pheochromocytoma was coined by Pick in 1912. Eighty-five percent of pheochromocytomas are adrenal and remaining 15% are extra-adrenal. Extra-adrenal pheochromocytomas are usually called paragangliomas. Pheochromocytoma as an entity is known since 1886 and its first successful surgical removal was reported in 1926 by Roux. Most of pheochromocytomas are sporadic and earlier only 10% were believed to be familial but in recent series up to 24% are reported to be familial where they may be associated with multiple endocrine neoplasia (2A and 2B), neurofibromatosis, Von-Hippel-Lindau syndrome, and human paragangliomas syndromes, cerebellar hemangio-blastoma, Sturge- Weber syndrome, and tuberous sclerosis. Extra-adrenal pheochromocytomas can be located along cranial nerves or vagus (parasympathetic), or they can be associated with sympathetic ganglia in pelvis, mediastinum, or neck. The most common extra-adrenal site in abdomen is at the origin of the inferior mesenteric artery called the area of Zuckerkandl.
http://www.ijem.in/article.asp?issn=2230-8210;year=2011;volume=15;issue=8;spage=329;epage=336;aulast=Garg
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