Pheochromocytoma, diagnosis and treatment: Review of the literature.

OBJECTIVE: We conducted an extensive review of the literature and tried to cite the most recent recommendations concerning the pheochromocytoma (PHEO). METHODS: Pub Med and Google Scholar databases were searched systematically for studies concerning pheochromocytomas (intra-adrenal paragangliomas) from 1980 until 2016. Bibliographies were searched to find additional articles. RESULTS: More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. If the results are equivocal then we perform the clonidine test. If we have not done it already, we preferably do a CT scan and/or an MRI scan. The patient needs pre-treatment with α1-blockers at least 10-14 days before operation. Alternatives or sometimes adjuncts are Calcium Channels Blockers and/or ß-Blockers. Several familial syndromes are associated with PHEO and genetic testing should be considered. CONCLUSIONS: The biggest problem for pheochromocytoma is to suspect it in the first place. Elevated metanephrines establish the diagnosis. With the proper preoperative preparation the risks during operation and the postoperative period are minimal. If there is a risk of the hereditable mutation, it is strongly suggested that all the patients with pheochromocytoma need clinical genetic testing.

Radiology of the adrenal incidentalomas. Review of the literature.

The term "adrenal incidentaloma" is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications exclusive to adrenal conditions (Udelsman 2001; Linos 2003; Bulow et al. 2006; Anagnostis et al. 2009). This definition excludes patients undergoing imaging testing as part of staging and work-up for cancer (Grumbach et al. 2003; Anagnostis et al. 2009). Papierska et al. (2013) have added the prerequisite that the size of a tumor must be "greater than 1cm in diameter", in order to be called incidentaloma. Although in the most cases these masses are non-hypersecreting and benign, they still represent an important clinical concern because of the risk of malignancy or hormone hyperfunction (Barzon et al. 2003). Th e adrenal tumors belong to the commonest incidental findings having been discovered (Kanagarajah et al. 2012).

Contribution by urban and agricultural pesticide uses to water contamination at the scale of the Marne watershed.

This study establishes an annual watershed (12,762 km(2)) budget of pesticide contamination in the Marne River based on detailed enquiries from farmers' organizations, public services and residents and pesticide usage. Results showed that urban uses were considerably lower (47 tons/yr) than agricultural ones (4300 tons/yr). However, the proportion of the amounts used transferred to surface water, differs considerably between urban and agricultural environments. Transfer from urban uses was estimated from runoff experiments with different surfaces, including concrete, tarmac, sand and gravel, and grass. Transfer coefficients from agricultural uses were derived from the calibrated value previously obtained from a detailed budget established for atrazine, taking into account the specific adsorption capacity (Koc) and half-life time of each substance used. The calculated annual budget shows a similar contribution by urban pesticides in the Marne River due to runoff over impervious surfaces as compared to agricultural pesticides used on cultivated soils (about 11 tons/yr in both cases). These estimates are consistent with data available from analytical surveys concerning pesticide occurrence in the rivers of the Paris region.