Vafi Salmasi1, Adam Schiavi2, Zev A Binder1,3, Jacob Ruzevick1, Brent A Orr4, Peter C Burger4, Douglas W Ball5, Ari M Blitz6, Wayne M Koch7, Masaru Ishii1,7, Gary L Gallia1,7. 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland. 4. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 6. Division of Neuroradiology, Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. METHODS: We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis. RESULTS: A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Workup revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade before the second stage. Serum catecholamine levels after this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in catecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. CONCLUSION: Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma.
BACKGROUND: Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. METHODS: We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis. RESULTS: A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Workup revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade before the second stage. Serum catecholamine levels after this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in catecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. CONCLUSION:Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma.
Authors: Y López Plasencia; M Boronat Cortés; D Marrero Arencibia; T Montenegro Dámaso; I Lisner Contreras; A Ojeda Pino; A Carrillo Domínguez; F La Roche Brier; Y García Delgado; F J Nóvoa Mogollón Journal: Head Neck Date: 2006-12 Impact factor: 3.147
Authors: Robbie S R Woods; Thavakumar Subramaniam; Mary Leader; Rory McConn-Walsh; James Paul O'Neill; Peter D Lacy Journal: J Neurol Surg B Skull Base Date: 2017-11-01