This tumor is occasionally familial or part of the multiglandular-neoplastic syndrome known as multiple endocrine adenoma type IIa or type IIb, and is manifested as an autosomal dominant trait. 55b Malignant spread, which occurs in less than 15% of pheochromocytomas, usually proceeds to venous and lymphatic channels with a predisposition for the liver. 55a Although usually found in the adrenal medulla, these vascular tumors can occur anywhere (referred to as paragangliomas), with a proportion of up to 20%. 55 This high mortality has been reduced with the improvements in anesthesia management during our current era. 54 Nevertheless, these tumors are clearly important to the anesthesiologist as previously 25% to 50% of hospital deaths in patients with pheochromocytoma occurred during induction of anesthesia or during operative procedures for other causes. Less than 0.1% of all cases of hypertension are caused by pheochromocytomas, or catecholamine-producing tumors derived from chromaffin tissue. Gropper MD, PhD, in Miller's Anesthesia, 2020 Adrenal Medullary Sympathetic Hormone Excess: Pheochromocytoma
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