Catecholamine-Secreting Paragangliomas: Recent Progress in Diagnosis and Perioperative Management

ABSTRACT

Catecholamine-secreting paragangliomas (CSPs) present challenges for the managing team of surgeons and anesthesiologists. Without proper preoperative management and planning, the patient is at high risk for complications and significant morbidity. A review of the literature looking at all aspects of the care of patients with CSP was performed to provide a consensus on the comprehensive care of these difficult patients. A case study is also provided to illustrate the management algorithm. Specific recommendations are made with regards to preoperative workup, including serum and urine testing, tumor localization, angiography, and embolization. Preoperative and intraoperative management techniques by the surgical and anesthesiology teams are discussed, including pharmaceutical interventions and fluid management. Aspects of postoperative care are also discussed. Management of patients with CSP requires significant attention to detail by a multidisciplinary team of surgeons and anesthesiologists. By following the recommendations included within this article, the morbidity associated with removal of these tumors can be significantly reduced or eliminated.

KEYWORDS

Paraganglioma - glomus tumor - catecholamine - perioperative management - diagnosis

REFERENCES

• 1 Erickson D, Kudva Y C, Ebersold M J et al.. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients.  J Clin Endocrinol Metab. 2001;  86 5210-5216
• 2 Schwaber M K, Glasscock M E, Nissen A J, Jackson C G, Smith P G. Diagnosis and management of catecholamine secreting glomus tumors.  Laryngoscope. 1984;  94 1008-1015
• 3 Spector G J, Ciralsky R, Maisel R H, Ogura J H. IV. Multiple glomus tumors in the head and neck.  Laryngoscope. 1975;  85 1066-1075
• 4 Netterville J L, Jackson C G, Miller F R, Wanamaker J R, Glasscock M E. Vagal paraganglioma: a review of 46 patients treated during a 20-year period.  Arch Otolaryngol Head Neck Surg. 1998;  124 1133-1140
• 5 Baysal B E, Ferrell R E, Willett-Brozick J E et al.. Mutations in SDHD, a mitochondrial complex II gene, in hereditary paraganglioma.  Science. 2000;  287 848-851
• 6 Drovdlic C M, Myers E N, Peters J A et al.. Proportion of heritable paraganglioma cases and associated clinical characteristics.  Laryngoscope. 2001;  111 1822-1827
• 7 van Houtum W H, Corssmit E PM, Douwes Dekker P B et al.. Increased prevalence of catecholamine excess and phaeochromocytomas in a well-defined Dutch population with SDHD-linked head and neck paragangliomas.  Eur J Endocrinol. 2005;  152 87-94
• 8 Amar L, Servais A, Gimenez-Roqueplo A P, Zinzindohoue F, Chatellier G, Plouin P F. 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
• 9 Lenders J WM, Pacak K, Walther M M et al.. Biochemical diagnosis of pheochromocytoma: which test is best?.  JAMA. 2002;  287 1427-1434
• 10 Eisenhofer G, Keiser H, Friberg P et al.. Plasma metanephrines are markers of pheochromocytoma produced by catechol-O-methyltransferase within tumors.  J Clin Endocrinol Metab. 1998;  83 2175-2185
• 11 Bravo E L, Tagle R. Pheochromocytoma: state-of-the-art and future prospects.  Endocr Rev. 2003;  24 539-553
• 12 Jalil N D, Pattou F N, Combemale F et al.. Effectiveness and limits of preoperative imaging studies for the localization of and paragangliomas: a review of 282 cases. French Association of Surgery (AFC), and The French Association of Endocrine Surgeons (AFCE).  Eur J Surg. 1998;  164 23-28
• 13 Maurea S, Cuocolo A, Reynolds J C, Neumann R D, Salvatore M. Diagnostic imaging in patients with paragangliomas. Computed tomography, magnetic resonance and MIBG scintigraphy comparison.  Q J Nucl Med. 1996;  40 365-371
• 14 Brink I, Hoegerle S, Klisch J, Bley T A. Imaging of pheochromocytoma and paraganglioma.  Fam Cancer. 2005;  4 61-68
• 15 Bustillo A, Telischi F, Weed D et al.. Octreotide scintigraphy in the head and neck.  Laryngoscope. 2004;  114 434-440
• 16 Telischi F F, Bustillo A, Whiteman M LH, Serafini A N et al.. Octreotide scintigraphy for the detection of paragangliomas.  Otolaryngol Head Neck Surg. 2000;  122 358-362
• 17 Muros M A, Llamas-Elvira J M, Rodríguez A et al.. 111In-pentetreotide scintigraphy is superior to 123I-MIBG scintigraphy in the diagnosis and location of chemodectoma.  Nucl Med Commun. 1998;  19 735-742
• 18 Hoegerle S, Ghanem N, Altehoefer C et al.. 18F-DOPA positron emission tomography for the detection of glomus tumours.  Eur J Nucl Med Mol Imaging. 2003;  30 689-694
• 19 Smith D F, Mihm F G, Mefford I. Hypertension after intraoperative autotransfusion in bilateral adrenalectomy for pheochromocytoma.  Anesthesiology. 1983;  58 182-184
• 20 Van Vliet P D, Burchell H B, Titus J L. Focal myocarditis associated with pheochromocytoma.  N Engl J Med. 1966;  274 1102-1108
• 21 Gupta K K. Letter: Phaeochromocytoma and myocardial infarction.  , [letter] Lancet. 1975;  1 281-282
• 22 Murphy T P, Brackmann D E. Effects of preoperative embolization on glomus jugulare tumors.  Laryngoscope. 1989;  99 1244-1247
• 23 Matishak M Z, Symon L, Cheeseman A, Pamphlett R. Catecholamine-secreting paragangliomas of the base of the skull. Report of two cases.  J Neurosurg. 1987;  66 604-608
• 24 Pandya S K, Nagpal R D, Desai A P, Purohit A V. Death following external carotid artery embolization for a functioning glomus jugulare chemodectoma. Case report.  J Neurosurg. 1978;  48 1030-1034
• 25 Nelson M D, Kendall B E. Intracranial catecholamine secreting paragangliomas.  Neuroradiology. 1987;  29 277-282
• 26 Plouin P F, Menard J, Corvol P. Hypertensive crisis in patient with phaeochromocytoma given metoclopramide.  , [letter] Lancet. 1976;  2 1357-1358
• 27 Mihm F G. Pulmonary artery pressure monitoring in patients with pheochromocytoma.  Anesth Analg. 1983;  62 1129-1133
• 28 Farrior J. Surgical management of glomus tumors: endocrine-active tumors of the skull base.  South Med J. 1988;  81 1121-1126