Feocromocitoma: a propósito de 3 casos clínicos

Autores

  • Ramiro Carvalho Serviço de Medicina II do Hospital Fernando Fonseca
  • Fátima Branquinho Serviço de Medicina II do Hospital Fernando Fonseca
  • João Sousa Ramos Serviço de Medicina II do Hospital Fernando Fonseca
  • José E. Carrasquinho Serviço de Medicina II do Hospital Fernando Fonseca
  • Rita Theias Serviço de Medicina II do Hospital Fernando Fonseca
  • José Calado Serviço de Medicina II do Hospital Fernando Fonseca
  • Fernando Ferrito Serviço de Medicina II do Hospital Fernando Fonseca
  • Cristina Carmona Serviço de Medicina II do Hospital Fernando Fonseca
  • Luís Dutschmann Serviço de Medicina II do Hospital Fernando Fonseca

Palavras-chave:

feocromocitoma, hipertensão arterial, metanefrina

Resumo

Os feocromocitomas são tumores neuroendócrinos raros que,
apesar de uma apresentação clínica altamente variável, muitas
vezes surgem associados a episódios de cefaleias, palpitações,
sudorese e hipertensão arterial. As complicações cardiovasculares, sérias e potencialmente fatais, devem-se a efeitos das
catecolaminas segregadas.
O estudo bioquímico destes tumores está indicado não apenas nos doentes sintomáticos, mas também em indivíduos com
acidentalomas supra-renais ou com predisposições genéticas
identificadas (Síndrome de Von Hippel Lindau, Neoplasia Endócrina Múltipla, tipo 2, Neurofibromatose-1).
Nesse sentido, os autores apresentam três casos clínicos
em que foi feito o diagnóstico bioquímico de feocromocitoma:
o primeiro referente a um jovem de 30 anos admitido para investigação no contexto de um acidentaloma supra-renal direito
com cerca de 6 cm de diâmetro; o segundo, uma jovem de 25
anos no decurso do estudo de hipertensão arterial e o terceiro
uma mulher de 59 anos, com antecedentes pessoais irrelevantes, que apresentava um nódulo supra-renal direito num exame
imagiológico de rotina.
Recorreu-se a métodos imagiológicos como tomografia computorizada (TC), ressonância magnética nuclear (RMN) e cintigrafia I
123-MIBG para localização dos tumores.
Após terapêutica pré-operatória adequada, para bloquear os
efeitos das catecolaminas segregadas, os doentes foram submetidos a laparoscopia, que decorreu sem intercorrências.
O prognóstico é excelente

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Referências

Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma, J Urol 1992; 147: 1-10.

Pacak K, Linehan WM, Eisenhofer G et al. Recent advances in genetics, diagnosis, localization and treatment of pheochromocytoma, Ann Intern Med 2001;134:315-329.

Anderson GH, Blakerman N et al. The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively reffered patients. J Hypertens 1994;12: 609-615.

Omura M, Saito J et al. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004;27: 193-202.

Sinclair AM, Isles CG et al. Secondary hypertension in a blood pressure clinic. Arch Intern Med 1987;147: 1289-1293.

Platts JK, Drew PJ. Death from pheochromocytoma: lessons from a post-mortem survey. J R Coll Physicians London 1995;29: 299-306.

Lo CY, Lam KY, Wat MS. Adrenal pheochromocytoma remains a frequently overlooked diagnosis. Am J Surg 2000;179: 212-215.

Khorram-Manesh A, Ahlman H et al. Mortality associated with pheochro-mocytoma in a large Swedish cohort. Eur J Surg Oncol 2004; 30: 556-559.

Plouin PF, Duclos JM et al. Factors associated wiyh perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab 2001; 86: 1480-1486.

Neumann HP, Bausch B et al. Germ line mutations in non syndromic pheochromocytoma. N Engl J Med 2002;346: 1459-1466.

Maher ER, Eng C. The pressure rises: update on the genetics of pheochromocytoma. Hum Mol Genet 2002;11: 2347-2354.

O’Riordain DS, Young WF et al. Clinical spectrum and outcome of functional extraadrenal paraganglioma. World J Surg 1996;20: 916-921.

Neumann HP, Berger DP et el. Pheochromocytomas, multiple endocrine neoplasia type 2 and von Hippel Lindau disease. N Engl J Med 1993;329: 1531-1538.

Manger WM, Gilford RW. Clinical and experimental pheochromocytoma. Second ed. Cambridge: Blackwell Sciences, 1996.

Manelli M, Ianni L et al. Pheochromocytoma in Italy : a multicentric retrospective study. Eur J Endocrinol 1999;141: 619-624.

Bravo El, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev 2003;24: 539-553.

Plouin PF, Degoulet P et al. Screening for pheochromocytoma in wich hypertensive patients? A semiological study of 2585 patients, including 11 with pheochromocytoma. Nouv Presse Med 1981;10: 869-872.

Batide-Alanore A, Chatellier G et al. Diabetes as a marker of pheochromocytoma in hypertensive patients. J Hypertens 2003;21: 1703-1707.

Kebebew E, Duh QY. Benign and malignant pheochromocytoma: diagnosis, treatment and follow-up. Surg Oncol Clin N Am1998;7: 765-789.

Mantero F, Terzolo M et al. A Survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000;85: 637-644.

Bryant J, Farmer J et al. Pheochromocytoma : the expanding genetic differential diagnosis. J Natl Cancer Inst 2003;95 : 1196-1204.

Baguet JP, Hammer L et al. Circumstances of discovery of pheochromocytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol 2004;150: 681-686.

Mansmann G, Lau J et al. The clinical inapparent adrenal mass : update in diagnosis and managment. Endocrin Rev 2004;25: 309-340.

Amar L, Servais A et al.Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 2005;90: 2110-2116.

Sheps SG, Jiang NS et al. Diagnostic evaluation of pheochromocytoma. Endocrinol Metab Clin North Am 1998;17: 397-414.

Pacak K, Chrousos GP et al. Pheochromocytoma. Progress in diagnosis, treatment and genetics. In: Margioris AN, Chrousos GP, eds. 1st edn. Totowa, NJ,USA: Humana Press 2001:79-413.

Lenders Jacques W M, Eisenhofer G et al. Pheochromocytoma. Lancet 2005;366: 665-675.

Kudva Yogish C, Sawka Anna M et al. The Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience. J Clin Endocrinol Metab 2003;88(10): 4533-4539.

Ioannis I, Pacak K. Clinical problem solving: Current Approaches and Recommended Algorithm for the Diagnostic Localization of Pheochromocytoma. J Clin Endocrinol Metab 2004;89(2): 479-491.

Kinney MA, Warner ME, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma ressection. Anesth Analg 2000;91: 1118-1123.

Quezado ZN, Keiser HR, et al. Reversible myocardial depression after massive catecholamine release from a pheochromocytoma. Crit Care Med 1992;20: 549-551.

Kobayashi T, Iwai A et al. Spontaneous rupture of adrenal pheochromocytoma: review and analysis of prognostic factors. J Surg Oncol 2005;90: 31-35.

Tauzin-Fin P, Sesay M et al. Effects of perioperative alpha 1 block on haemodynamic control during laparoscopic surgery for pheochromocytoma. Br J Anaesth 2004;92: 512-517.

Prys-Roberts C. Pheochromocytoma-recent progress in its managment. Br J Anaesth 2000;85: 44-57.

Lebuffe G, Dosseh ED, et al. The effect of calcium channel blockers on outcome following the surgical treatment of pheochromocytomas and para-gangliomas. Anaesthesia 2005;60: 439-444.

Steinsapir J, Carr AA et al. Metyrosine and pheochromocytoma. Arch Intern Med 1997;157: 901-906.

Kinney MA, Narr BJ et al. Perioperative managment of pheochromocytoma. J Cardiothorac Vasc Anesth 2002;16: 359-369.

Roizen MF, Schreider BD et al. Anesthesia for patients with pheochromocytoma. Anesthesiol Clin North Am 1987 ;5 : 269-275.

Janetschek G, Finkenstedt G et al. Laparoscopic Surgery for Pheochromocytoma: adrenalectomy, partial ressection, excision of paragangliomas. J Urol 1998; 160:330-334.

Eisenhofer G, Bornstein SR et al. Malignant Pheochromocytoma: current status and initiatives for future progress. Endocr Relat Cancer 2004;11:423-436

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Publicado

31-03-2009

Como Citar

1.
Carvalho R, Branquinho F, Sousa Ramos J, Carrasquinho JE, Theias R, Calado J, Ferrito F, Carmona C, Dutschmann L. Feocromocitoma: a propósito de 3 casos clínicos. RPMI [Internet]. 31 de Março de 2009 [citado 22 de Maio de 2024];16(1):43-9. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1385

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