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See detailEctopic Hormones-Secreting Pheochromocytoma: A Francophone Observational Study
KIRKBY-BOTT, James; BRUNAUD, Laurent; MATHONET, Muriel et al

in World Journal of Surgery (2012), 36

Background Ectopic hormone-secreting pheochromocytomas <br />are rare; only case reports exist in the literature. This <br />condition has been linked with increased malignancy, <br />familial syndromes ... [more ▼]

Background Ectopic hormone-secreting pheochromocytomas <br />are rare; only case reports exist in the literature. This <br />condition has been linked with increased malignancy, <br />familial syndromes, and ACTH secretion. We wanted to <br />test these hypotheses and shed light on the nature of ectopic <br />hormone-secreting pheochromocytomas. <br />Methods This is a multicenter (francophone) observational <br />study. Inclusion was based upon abnormal preoperative <br />hormone tests in patients with pheochromocytoma <br />that normalized after removal of the tumor. Where <br />possible, immunohistochemistry was performed to confirm <br />that ectopic secretion came from the tumor. <br />Results Sixteen cases were found: nine female and seven <br />male patients. Median age was 50.5 (range 31–89) years. <br />Most presented with hypertension, diabetes, or cushingoid <br />features. Ten patients had specific symptoms from the <br />ectopic hormone secretion. Two had a familial syndrome. <br />Of eight patients with excess cortisol secretion, three died <br />as a result of the tumor resection: two had pheochromocytomas[ <br />15 cm and their associated cortisol hypersecretion <br />complicated their postoperative course. The other died <br />from a torn subhepatic vein. The 13 survivors did not <br />develop any evidence of malignancy during follow-up <br />(median 50 months). Symptoms from the ectopic secretion <br />resolved after removal of the tumor. Immunohistochemistry <br />was performed and was positive in eight tumors: five <br />ACTH, three calcitonins, and one VIP. <br />Conclusions Most pheochromocytomas with ectopic <br />secretion are neither malignant nor familial. Most ectopic <br />hormone-secreting pheochromocytoma cause hypercortisolemia. <br />Patients with a pheochromocytoma should be <br />worked up for ectopic hormones, because removal of the <br />pheochromocytoma resolves those symptoms. Associated <br />cortisol secretion needs careful attention. [less ▲]

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See detailElectrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement
Randolph, Gregory; Dralle, Henning; Abdullah, hisham et al

in Laryngoscope (2011), 121

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See detailMulticenter Study of 19 Aortopulmonary Window parathyroid Tumors : The callenge of Embryologic origin
Arnault, Vincent; Beaulieu, Anthony; Lifante, Jean-Christophe et al

in World Journal of Surgery (2010), 34

Background Ectopic abnormal parathyroid glands are relatively common in the superior mediastinum but are rarely situated in the aortopulmonary window (APW). The embryological origin of these abnormal ... [more ▼]

Background Ectopic abnormal parathyroid glands are relatively common in the superior mediastinum but are rarely situated in the aortopulmonary window (APW). The embryological origin of these abnormal parathyroid glands is controversial. The purpose of this investigation was to investigate the embryological origin and the surgical management of abnormal parathyroid glands situated in the APW. Methods The databases of patients operated on for primary, secondary, and tertiary hyperparathyroidism at eight European medical centers with a special interest in endocrine surgery were reviewed to identify those with APW adenomas. Demographic features, localization procedures, and perioperative and pathology findings were documented. The embryological origin was determined based on the number and position of identified parathyroid glands. Results Nineteen (0.24%) APW parathyroid tumors were identified in 7,869 patients who underwent an operation for hyperparathyroidism (HPT) and 181 patients (2.3%) with mediastinal abnormal parathyroid glands. Ten patients had primary, eight had secondary, and one had tertiary HPT. Sixteen patients had undergone previous unsuccessful cervical exploration. In three patients, an APW adenoma was suspected by preoperative localization studies and was cured at the initial operation. Sixteen patients had persistent HPTof whom 15 were reoperated, resulting in 6 failures. Evaluation of 17 patients who had bilateral neck exploration allowed us to determine the most probable origin of the APW parathyroid tumors: 12 were supernumerary, 4 appeared to originate from a superior, and 1 from an inferior gland. Conclusions Abnormal parathyroid glands situated in the APW are rare and usually identified after an unsuccessful cervical exploration. Preoperative imaging of the mediastinum and neck are essential. The origin of these ectopically situated tumors is probably, as suggested by our data, from a supernumerary fifth parathyroid gland or from abnormal migration of a superior parathyroid gland during the embryologic development. [less ▲]

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