title: Constipation: an overlooked, unmanaged symptom of patients with pheochromocytoma and sympathetic paraganglioma.
abstract: OBJECTIVE
  Pheochromocytomas (PHs) and sympathetic paragangliomas (PGs) are tumors that produce catecholamines, predisposing patients to cardiovascular disease and gastrointestinal effects such as constipation.
  
  
  OBJECTIVE
  i) determine the prevalence of constipation, its risk factors, and its impact on survival; ii) identify whether a systematic combination of fiber, water, and laxatives was effective for treatment of constipation.
  
  
  METHODS
  We retrospectively studied 396 patients with PH/PG diagnosed in 2005-2014. The study population was patients with constipation as a presenting symptom; the control group was patients without constipation as a presenting symptom. The MD Anderson Symptom Inventory was used to assess constipation and quality of life.
  
  
  RESULTS
  Twenty-three patients (6%) had constipation. Constipation was associated with headaches, palpitations, diaphoresis, weight loss, and excessive noradrenaline production (P<0.0001). Eighteen of these patients had non-metastatic primary tumors larger than 5 cm and/or extensive metastases. No statistically significant differences in age, sex, and genotype were noted between the study and control groups. In patients without metastases, resection of the primary tumor led to symptom disappearance. A systematic combination of fiber, water, and laxatives was associated with symptom improvement. Two patients who presented unmanaged constipation died because of sepsis from toxic megacolon.
  
  
  CONCLUSIONS
  Constipation is a rare and potentially lethal complication in patients with PH/PGs. Severe constipation can be prevented by recognizing and treating mild symptoms.
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Thosani
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Ayala-Ramirez
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Román-González
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Shouhao
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Bisanz
authors.affiliation: Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1461, Houston, Texas 77030, USADepartment of EndocrinologyHospital San Vicente Fundacion-Universidad de Antioquia, Medellin, ColombiaDepartment of BiostatisticsThe University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of GastroenterologyHepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas, USAIndependent Nurse Consultantretired from The University of Texas MD Anderson Cancer Center, Houston, Texas, USA cjimenez@mdanderson.org.
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D004043:Dietary Fiber / Q000627:therapeutic use*; D060766:Drinking Water; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D008297:Male; D008532:Megacolon, Toxic / Q000517:prevention & control; D008875:Middle Aged; D010236:Paraganglioma, Extra-Adrenal / Q000150:complications*; D010673:Pheochromocytoma / Q000150:complications*; D011788:Quality of Life; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004043:Dietary Fiber; D060766:Drinking Water; D054368:Laxatives