RESUMO
The patient, a 40-year-old woman, was diagnosed as having a functional right vagal paraganglioma (PGL) 15 years after undergoing resection for a retroperitoneal PGL. 123I-MIBG scintigraphy showed no accumulation, but as the blood noradrenaline and urinary normetanephrine concentrations were elevated, the tumor was judged as being functional, and surgery was scheduled. The patient was started on doxazosin infusion and embolization of the tumor feeding vessel was performed before the surgery. Intraoperative examination showed that the tumor was contiguous with the vagal nerve, necessitating combined resection of the vagal nerve with the tumor. Postoperatively, the catecholamine levels returned to normal range. Histopathologically, the tumor was diagnosed as a moderately differentiated, intermediate-malignant-grade PGL, with a GAPP score of 4 to 6. No non-chromaffin tissue was observed in the tumor background, so that the functional vagal PGL was considered as a sporadic metachronous tumor rather than as a metastasis from the retroperitoneal PGL. More than half of head and neck paragangliomas (HNPGLs) are reported to arise in the carotid body, and about 5% from the vagal nerve. In addition, HNPGLs rarely produce catecholamines. Herein, we consider the relationship with the previously resected retroperitoneal PGL based on a review of the literature.
Assuntos
Paraganglioma , Neoplasias Retroperitoneais , Humanos , Feminino , Adulto , Neoplasias Retroperitoneais/cirurgia , Neoplasias Retroperitoneais/patologia , Paraganglioma/cirurgia , Paraganglioma Extrassuprarrenal/cirurgia , Paraganglioma Extrassuprarrenal/patologia , Normetanefrina/urina , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Doenças do Nervo Vago/cirurgia , Embolização Terapêutica , Norepinefrina/sangue , Nervo VagoRESUMO
INTRODUCTION: Incidentaloma is an adrenal tumor detected during diagnostic imaging performed for extraadrenal causes. Evaluation of metanephrine concentrations in a 24hour urine collection can be a significant challenge in patients with multiple medications and comorbidities. OBJECTIVES: The aim of this study was to evaluate the effect of commonly used groups of drugs on metanephrine levels in the 24hour urine collection. PATIENTS AND METHODS: A total of 1051 patients with adrenal mass below 10 Hounsfield units on unenhanced computed tomography were included in the study. Patients diagnosed with Cushing or Conn syndrome, adrenal carcinoma, pheochromocytoma, active extraadrenal malignant neoplasms, and exacerbation of severe illnesses were excluded. Metanephrine, normetanephrine, and 3methoxytyramine in the 24hour urine collection were measured by highperformance liquid chromatography with electrochemical detection. Information on concomitant medication (ßblockers, calcium channel blockers [CCBs], loop diuretics, thiazide diuretics, potassiumsparing diuretics, αblockers, angiotensinconverting enzyme inhibitors / angiotensin II receptor blockers, metformin, nonmetformin antidiabetic drugs [NMADs], lipidlowering drugs, proton pump inhibitors, levothyroxine, thyreostatics, antidepressants, neuroleptics, benzodiazepines, glucocorticosteroids, inhaled Breceptor agonists, and ipratropium) was collected from each patient. RESULTS: The urinary excretion of normetanephrine was significantly higher in the patients on ßblockers, CCBs, loop diuretics, αblockers, NMADs, and neuroleptics. αBlockers increased urine metanephrine concentration, and NMADs, antidepressants, and glucocorticosteroids lowered it. There was no association between the analyzed drugs and urinary 3methoxytyramine level. CONCLUSIONS: Many drug groups interfere with the measurement of urinary fractionated metanephrines. These interactions should be taken into account during interpretation of a hormonal evaluation, as they can be crucial for further management, especially for making a decision on surgical treatment.
Assuntos
Neoplasias das Glândulas Suprarrenais , Antipsicóticos , Dopamina/análogos & derivados , Humanos , Metanefrina/urina , Normetanefrina/urina , Neoplasias das Glândulas Suprarrenais/cirurgia , Antidepressivos , DiuréticosRESUMO
O avanço tecnológico na obtençäo de imagens em medicina (ultrassonografia, tomografia computadorizada e ressonância nuclear magnética) tem proporcionado uma precisäo de detalhes cada vez maior. Por isso, a incidência de achados de massas acidentais está aumentando na mesma proporçäo, obrigando-nos a deparar com novos desafios diagnósticos e terapêuticos. O incidentaloma da adrenal apresenta-se nesta categoria, constituindo um problema diagnóstico e um dilema terapêutico. O feocromocitoma é um tumor raro, que incide em apenas 0,1 por cento dos indivíduos hipertensos e se carateriza por extrema variabilidade na sua expressäo clínica. Raramente o tumor é clinicamente silencioso, porém, frequentemente, seu diagnóstico é estabelecido somente após remoçäo de um incidentaloma adrenal ou autópsia. Neste relato de caso apresentamos uma paciente assintomática, portadora de feocromocitoma silencioso, com aumento apenas dos níveis de normetanefrinas urinárias, alertando para a importância da investigaçäo funcional destas massas encontradas incidentalmente. Os resultados alterados em apenas um dos metabólitos urinários de catecolaminas (HPLC) confirmam achados prévios, de serem estes os mais sensíveis para investigaçäo dos incidentalomas adrenais na detecçäo de feocromocitomas.
Assuntos
Humanos , Feminino , Adulto , Neoplasias das Glândulas Suprarrenais/diagnóstico , Normetanefrina/urina , Feocromocitoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/urina , Feocromocitoma/urinaRESUMO
En este trabajo se han compilado los distintos modos cromatográficos y sistemas de detección utilizados en la cromatografía líquida de alta resolución de aminas biogénicas. Se indican las características generales del intercambio catiónico, fase reversa, fase reversa de pares iónicos y cromatografía de partición con fase reversa de pares iónicos. También se analizan comparativamente la detección UV, detección fluorimétrica usando fluorescencia nativa o bien derivatización pre- y postcolumna y detección electroquímica de gran utilidad para esta extensa familia de compuestos. Se dan ejemplos de aplicación de interés en el campo bioquímico-clínico, con el análisis de ácido homovainillínico, ácido 3,4-dihidroxifenilacético y ácido 5-hidroxiindolacético en líquido cefalorraquídeo, metanefrinas, ácido 3,4-dihidroxifenilacético, catecolaminas, ácidos urinarios y 3-metoxi-4-hidroxifenilglicol en orina, catecolaminas y 3-metoxi-4-hidroxifenilglicol en plasma, catecolaminas, 3-metoxi-4-hidroxifenilglicol y otros neurotransmisores en cerebro de rata. Se discuten, también, los tratamientos previos requeridos especialmente para orina y plasma, así como las condiciones de conservación y su incidencia en los resultados obtenidos