Florence Rochelle C. Gan, Ma. Felisse S. Gomez, Leilani B. Mercado-Asis
Oct 2019 DOI 10.35460/2546-1621.2019-0022 Access
Systemic unloading of adrenaline improves blood pressure (BP) but the effect on the quality of life is not emphasized. This report aims to examine the outcome of systemic hormonal unloading through unilateral adrenalectomy in three pheochromocytoma cases.
Case 1: 20-year-old male presented with anxiety, severe headaches and BP 150/100 mmHg, taking terazosin and amlodipine. Stimulated bilateral adrenal venous sampling with glucagon stimulation (SBAVS-GS) showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he is asymptomatic with usual BP 110-120/60-70 mmHg without medication.
Case 2: 51-year-old male presented with panic attacks, sweating, palpitations, headaches and BP 220/110 mmHg, given terazosin and amlodipine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he reported reduction of symptoms. His usual BP is 100-130/60-80 mmHg on low dose amlodipine.
Case 3: 27-year-old female presented with severe headache, dizziness, spontaneous epistaxis, palpitations and BP 210/140 mmHg, taking bisoprolol, terazosin and clonidine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, she had less headache and dizziness. Her BP is 110-140/70-90 mmHg on a single anti-hypertensive drug.
Conclusion: Systemic hormonal unloading via unilateral adrenalectomy of the dominantly hormonal secreting adrenal gland is a good treatment option for pheochromocytoma; consequently, improving quality of life significantly.
- Zuber SM, Kantorovich V, Pacak K. Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am. 2011;40(2):295–311.
- Stolk RF, Mulder J, Timmers HJLM, Lenders JWM. Is the excess cardiovascular morbidity in pheochromocytoma related to blood pressure or to catecholamines? JCEM. 2013;98(3):1100–6.
- Vetter H, Vetter W, Warnholz C, Bayer JM, Käser H, Vielhaber K, et al. Renin and aldosterone secretion in pheochromocytoma. Effect of chronic alpha-adrenergic receptor blockade. Am J Med. 1976;60(6):866–71.
- Mercado-Asis LB, Siao RM, Amba NF. Evolving clinical presentation and assessment of pheochromocytoma: a review. JMUST. 2017;1:5–22.
- Soltani A, Pourian M, Davani B. Does this patient have pheochromocytoma? a systematic review of clinical signs and symptoms, J Diabetes Metab Disord. 2016;15:6:1–12.
- Zianni D, Tzanela M, Klimpoulos S, Thalassinos NC. Symptomatic pheochromocytoma with normal urinary catecholamine metabolites. Hormones. 2004;3(2);132–7.
- Mercado-Asis LB, Tingcungco AG, Bolong DT, Lopez RA, Caguioa EV, Yamamoto ME, et al. Diagnosis of small adrenal pheochromocytoma by adrenal venous sampling with glucagon stimulation test. Int J of Endocrinol Metab. 2011(9):323–9.
- Malong CLP, Tanchee-Ngo MJ, Torres-Salvador P, et al. Removal of dominant adrenal lateralized by glucagon-stimulated adrenal venous sampling alleviates hypertension in bilateral pheochromocytoma. Journal of Life Sciences. 2013;7(6):116–21.
- Brouwers FM, Eisenhofer G. Lenders JW, et al. Emergencies caused by pheochromocytoma, neuroblastoma or ganglioneuroma. Endocrinol Metab Clin North Am. 2006;35:699–724.
- Pacak K. Pheochromocytoma resection: the rule of surgical divergence. AACE Clinical Case Reports. 2016;2(1):e78–9.
- Ferreira VM, Marcelino M, Piechnik SK, Marini C, Karamitsos TD, Ntusi NAB, et al. Pheochromocytoma is characterized by catecholamine-mediated myocarditis, focal and diffuse myocardial fibrosis, and myocardial dysfunction. J Am Coll Cardiol. 2016;67(20):2364–74.
- Zhou GW, Wei Y, Chen X, Jiang XH, Li XY, Ning G, et al. Diagnosis and surgical treatment of multiple endocrine neoplasia. Chin Med J (Engl). 2009;122(13):1495–500.
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