KUMJ | VOL. 10 | NO. 3 | ISSUE 39 | JUL-SEP, 2012
Phaeochromocytoma in Nepal – A Single Centre Experience
Maskey P, Shrestha GK, Luitel BR, Gupta DK, Sidarth, Chalise PR, Sharma UK, Gyawali PR Joshi BR
Abstract: Background
Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that
classically present with symptoms of catecholamine excess such as palpitations,
headache and sweating. They are diagnosed by measuring plasma or urinary levels
of catecholamines or their metabolites. Anatomic localization is done by computed
tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine
scan in certain cases. Adequate preoperative catecholamine blockade prevents
perioperative hemodynamic instability.
Objectives
To study the clinical spectrum and management of phaeochromocytomas in a
tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal.
Methods
Retrospective review of case records of histologically proven cases of
phaeochromocytomas from 2008 -2011 was done, and data collected on clinical
spectrum, diagnostic modalities, perioperative management and follow-up.
Results
Tweleve cases of phaeochromocytomas were operated. The mean age was
36.41±14.07 years. There were 2 bilateral phaeochromocytomas and 1 extraadrenal
paraganglioma. Apart from the common symptoms of catecholamine
excess, patients had atypical presentations like psychiatric manifestations and
blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed
tomographic scan was used for diagnosis, and open surgery was done in all cases.
Pre-operative blood pressure control was achieved by prazocin or calcium channel
blockers. Ten patients had intraoperative surge in blood pressure. There were
no major morbidity or mortality. Three patients had high blood pressure postoperatively,
but were effectively managed with antihypertensives.
Conclusion
Phaeochromocytomas can have variable presentation. Good preoperative
preparation and perioperative management can result in an excellent outcome.
Keyword : Hypertension, Paraganglioma, Phaeochromocytoma, Prazocin, Vanillyl Mandelic Acid
