title: Phaeochromocytoma in Nepal--a single centre experience.
abstract: BACKGROUND
  Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability.
  
  
  OBJECTIVE
  To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal.
  
  
  METHODS
  Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up.
  
  
  RESULTS
  Twelve cases of phaeochromocytomas were operated. The mean age was 36.41+/-14.07 years. There were 2 bilateral phaeochromocytomas and 1 extraadrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure postoperatively, but were effectively managed with antihypertensives.
  
  
  CONCLUSIONS
  Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome.
authors: Department of Surgery, Tribhuvan University Teaching Hospital Maharajgunj, Kathmandu, Nepal. pukarmaskey@hotmail.com
authors: P
authors: P
authors: Maskey
authors: G K
authors: GK
authors: Shrestha
authors: B R
authors: BR
authors: Luitel
authors: D K
authors: DK
authors: Gupta
authors: Sidarth
authors: P R
authors: PR
authors: Chalise
authors: U K
authors: UK
authors: Sharma
authors: P R
authors: PR
authors: Gyawali
authors: B R
authors: BR
authors: Joshi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D010236:Paraganglioma, Extra-Adrenal / Q000175:diagnosis*; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D014642:Vanilmandelic Acid / Q000652:urine*
chemical_list: D014642:Vanilmandelic Acid