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Catecholamine-secreting carotid body paraganglioma: successful preoperative control of hypertension and clinical symptoms using high-dose long-acting octreotide.

Elshafie O, Al Badaai Y, Alwahaibi K, Qureshi A, Hussein S, Al Azzri F, Almamari A, Woodhouse N - Endocrinol Diabetes Metab Case Rep (2014)

Bottom Line: Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck.To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP.The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma.Control of catecholamine secretion using high-dose octreotide.This is a report of a rare cause of secondary diabetes and hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.

ABSTRACT

Unlabelled: A 48-year-old hypertensive and diabetic patient presented with a 10-year history of progressive right facial pain, tinnitus, hearing loss, sweating, and palpitations. Investigations revealed a 5.6 cm vascular tumor at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20 mg od and amlodipine 10 mg od and 100 U of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP) was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE) level, 89 000 pmol/l, and chromogranin A (CgA) level, 279 μg/l. Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100 μg 8 h, the NE level dropped progressively from 50 000 to 25 000 pmol/l and CgA from 279 to 25 μg/l. Treatment was therefore continued with labetalol 200 mg twice daily (bid) and long-acting octreotide-LA initially using 40 mg/month and later increasing to 80 mg/month. On this dose and with a reduced labetalol intake of 100 mg bid, BP was maintained at 130/70 and her symptoms resolved completely. CgA levels returned to normal in the first week and these were maintained throughout the 3 month treatment period. During tumor resection, there were minimal BP fluctuations during the 10 h procedure. We conclude that short-term high-dose octreotide-LA might prove valuable in the preoperative management of catecholamine-secreting tumors. To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP.

Learning points: The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma.Control of catecholamine secretion using high-dose octreotide.This is a report of a rare cause of secondary diabetes and hypertension.

No MeSH data available.


Related in: MedlinePlus

Serum CgA levels before and during treatment with octreotide.
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fig4: Serum CgA levels before and during treatment with octreotide.

Mentions: The dose of octreotide was therefore increased to 80 mg a month, a dose similar to that which has proved successful in resistant cases of acromegaly (4). She improved dramatically with loss of all her presenting symptoms. Her hearing aid was discarded. The labetalol was reduced to 100 mg bid after 1 month and was stopped three days before tumor embolization with maintenance of a normal BP of 135/80 and a slightly elevated NE level of 5000 pmol/l (Fig. 2). Blood flow before and after embolization is shown in Fig. 4a and b. The surgery was uneventful with only three mild BP spikes occurring during the 10-h procedure when the tumor 5.6×5 cm was resected completely (Fig. 5).


Catecholamine-secreting carotid body paraganglioma: successful preoperative control of hypertension and clinical symptoms using high-dose long-acting octreotide.

Elshafie O, Al Badaai Y, Alwahaibi K, Qureshi A, Hussein S, Al Azzri F, Almamari A, Woodhouse N - Endocrinol Diabetes Metab Case Rep (2014)

Serum CgA levels before and during treatment with octreotide.
© Copyright Policy - license
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120363&req=5

fig4: Serum CgA levels before and during treatment with octreotide.
Mentions: The dose of octreotide was therefore increased to 80 mg a month, a dose similar to that which has proved successful in resistant cases of acromegaly (4). She improved dramatically with loss of all her presenting symptoms. Her hearing aid was discarded. The labetalol was reduced to 100 mg bid after 1 month and was stopped three days before tumor embolization with maintenance of a normal BP of 135/80 and a slightly elevated NE level of 5000 pmol/l (Fig. 2). Blood flow before and after embolization is shown in Fig. 4a and b. The surgery was uneventful with only three mild BP spikes occurring during the 10-h procedure when the tumor 5.6×5 cm was resected completely (Fig. 5).

Bottom Line: Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck.To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP.The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma.Control of catecholamine secretion using high-dose octreotide.This is a report of a rare cause of secondary diabetes and hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.

ABSTRACT

Unlabelled: A 48-year-old hypertensive and diabetic patient presented with a 10-year history of progressive right facial pain, tinnitus, hearing loss, sweating, and palpitations. Investigations revealed a 5.6 cm vascular tumor at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20 mg od and amlodipine 10 mg od and 100 U of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP) was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE) level, 89 000 pmol/l, and chromogranin A (CgA) level, 279 μg/l. Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100 μg 8 h, the NE level dropped progressively from 50 000 to 25 000 pmol/l and CgA from 279 to 25 μg/l. Treatment was therefore continued with labetalol 200 mg twice daily (bid) and long-acting octreotide-LA initially using 40 mg/month and later increasing to 80 mg/month. On this dose and with a reduced labetalol intake of 100 mg bid, BP was maintained at 130/70 and her symptoms resolved completely. CgA levels returned to normal in the first week and these were maintained throughout the 3 month treatment period. During tumor resection, there were minimal BP fluctuations during the 10 h procedure. We conclude that short-term high-dose octreotide-LA might prove valuable in the preoperative management of catecholamine-secreting tumors. To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP.

Learning points: The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma.Control of catecholamine secretion using high-dose octreotide.This is a report of a rare cause of secondary diabetes and hypertension.

No MeSH data available.


Related in: MedlinePlus