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A case of strange cardiac rhythms.

Zeier MG, Kettritz R, Luft FC - Clin Kidney J (2012)

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Critical Care Medicine , Charité Medical Faculty, Virchow Klinikum Campus.

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Our patient presented intubated and on extracorporeal membrane oxygenation... A routinely performed computed tomography (CT) scan showed no evidence of fractures, acute respiratory distress syndrome (ARDS) or an abdominal mass (Figure 1)... The 5 cm diameter cystic lesion residing adjacent to the left kidney and the 1.7 cm solid lesion found adjacent to the right kidney led us to perform some more diagnostic tests... They are catecholamine-producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia... The tumours from extra-adrenal chromaffin tissue are referred to as extra-adrenal phaeochromocytomas or paragangliomas... The term paraganglioma is also used for the tumours derived from parasympathetic tissue in the head and neck, most of which do not produce catecholamines... Nearly 80–85% of phaeochromocytomas arise from the adrenal medulla, whereas about 15–20% are from extra-adrenal chromaffin tissue... Exaggerated sympathetic stimulation may play a pathogenic role in the development of SCM... The plasma catecholamine levels have been found to be markedly elevated in some patients with SCM, and the syndrome has also been observed in other clinical states of catecholamine excess such as central neurologic injury and phaeochromocytoma... Our patient had undergone cardiac compression during resuscitation and was critically ill, requiring ECMO, precluding a precise cardiac workup... We found no evidence of coronary disease and whether or not he had SCM prior to his fall is unknown... We counselled the good professor to leave the cherry picking to someone else... None declared.

No MeSH data available.


Left panel shows CT positron emission tomography; right shows the results of meta-iodo-benzylguanidine (MIBG) scintigraphy (Res ipse loquitur).
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SFS156F2: Left panel shows CT positron emission tomography; right shows the results of meta-iodo-benzylguanidine (MIBG) scintigraphy (Res ipse loquitur).

Mentions: The 5 cm diameter cystic lesion residing adjacent to the left kidney and the 1.7 cm solid lesion found adjacent to the right kidney led us to perform some more diagnostic tests. The levels of plasma metanephrines were 1774 pg/mL (normal <80 pg/mL), and normetanephrines were 2471 pg/mL (normal <200 pg/mL). In the urine, epinephrine, norepinephrine, vanyl mandelic acid and dopamine levels were all markedly elevated, while the serum aldosterone concentration was within the normal limits. Although the patient was not severely hypertensive in the intensive care unit, we treated him preoperatively with 0.9% saline, phenoxybenzamine and then added nebivolol as labetolol is no longer available in Germany. Happily, the good professor recovered from ARDS, was stabilized and extubated. Cooperative surgeons removed the catecholamine-producing left adrenal mass laparoscopically after the additional imaging studies shown below were completed (Figure 2). The phaeochromocytoma was benign and the patient could leave the hospital much improved in all respects.Fig. 2.


A case of strange cardiac rhythms.

Zeier MG, Kettritz R, Luft FC - Clin Kidney J (2012)

Left panel shows CT positron emission tomography; right shows the results of meta-iodo-benzylguanidine (MIBG) scintigraphy (Res ipse loquitur).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400571&req=5

SFS156F2: Left panel shows CT positron emission tomography; right shows the results of meta-iodo-benzylguanidine (MIBG) scintigraphy (Res ipse loquitur).
Mentions: The 5 cm diameter cystic lesion residing adjacent to the left kidney and the 1.7 cm solid lesion found adjacent to the right kidney led us to perform some more diagnostic tests. The levels of plasma metanephrines were 1774 pg/mL (normal <80 pg/mL), and normetanephrines were 2471 pg/mL (normal <200 pg/mL). In the urine, epinephrine, norepinephrine, vanyl mandelic acid and dopamine levels were all markedly elevated, while the serum aldosterone concentration was within the normal limits. Although the patient was not severely hypertensive in the intensive care unit, we treated him preoperatively with 0.9% saline, phenoxybenzamine and then added nebivolol as labetolol is no longer available in Germany. Happily, the good professor recovered from ARDS, was stabilized and extubated. Cooperative surgeons removed the catecholamine-producing left adrenal mass laparoscopically after the additional imaging studies shown below were completed (Figure 2). The phaeochromocytoma was benign and the patient could leave the hospital much improved in all respects.Fig. 2.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Critical Care Medicine , Charité Medical Faculty, Virchow Klinikum Campus.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Our patient presented intubated and on extracorporeal membrane oxygenation... A routinely performed computed tomography (CT) scan showed no evidence of fractures, acute respiratory distress syndrome (ARDS) or an abdominal mass (Figure 1)... The 5 cm diameter cystic lesion residing adjacent to the left kidney and the 1.7 cm solid lesion found adjacent to the right kidney led us to perform some more diagnostic tests... They are catecholamine-producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia... The tumours from extra-adrenal chromaffin tissue are referred to as extra-adrenal phaeochromocytomas or paragangliomas... The term paraganglioma is also used for the tumours derived from parasympathetic tissue in the head and neck, most of which do not produce catecholamines... Nearly 80–85% of phaeochromocytomas arise from the adrenal medulla, whereas about 15–20% are from extra-adrenal chromaffin tissue... Exaggerated sympathetic stimulation may play a pathogenic role in the development of SCM... The plasma catecholamine levels have been found to be markedly elevated in some patients with SCM, and the syndrome has also been observed in other clinical states of catecholamine excess such as central neurologic injury and phaeochromocytoma... Our patient had undergone cardiac compression during resuscitation and was critically ill, requiring ECMO, precluding a precise cardiac workup... We found no evidence of coronary disease and whether or not he had SCM prior to his fall is unknown... We counselled the good professor to leave the cherry picking to someone else... None declared.

No MeSH data available.