canis - Articles
Pheochromocytoma
Introduction
- Cause: tumors derived from chromaffin cells in adrenal medulla; occasionally extra-adrenal (paraganglioma).
- Physiopathology: may invade caudal vena cava and/or metastasize to lung, liver or bone.
- Signs: can be incidental finding at post-mortem or during abdominal ultrasound or CT; or vague systemic signs, ie intermittent tachycardia, hypertension, excitability, ataxia and collapse.
- Diagnosis: radiography/ultrasound, blood pressure measurements, eye fundus examination, normetanephrine concentration in urine or plasma.
- Treatment: surgery, medical for hypertension. Chemotherapy and stereotactic radiation therapy for non-operable tumors.
- Prognosis: good if surgery successful, no metastases, concurrent illness treated also.
Presenting signs
- Intermittent collapse.
- Weakness.
- Anorexia.
- Vomiting/diarrhea.
- Restlessness, panting.
Age predisposition
- Older animals (mean 11 years).
Special risks
- Anesthesia and surgery as changes in blood flow on induction or trauma can → stimulation of catecholamine release → hypertension and cardiac arrhythmias.
Pathogenesis
Pathophysiology
- Signs related to episodic secretion of catecholamines and their systemic effects.
- Vascular invasion in up to 80% cases.
- Metastasis (liver, spleen, lung, lymph nodes, CNS, bone) reported in up to 40% of patients.
Timecourse
- Weeks to years.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- van den Berg M F, Kooistra H S, Grinwis G C M et al (2023) Reference intervals for plasma, urinary, and salivary concentrations of free metanephrines in dogs: Relevance to the diagnosis of pheochromocytoma J Vet Int Med 37 (1), 173-183 PubMed.
- Linder T, Wakamatsu C, Jacovino J et al (2023) Stereotactic body radiation therapy as an alternative to adrenalectomy for the treatment of pheochromocytomas in 8 dogs. Vet Comp Oncol 21 (1), 45-53 PubMed.
- Enright D, Dickerson V M, Grimes J A et al (2022) Short- and long-term survival after adrenalectomy in 53 dogs with pheochromocytomas with or without alpha-blocker therapy. Vet Surg 51 (3), 438-446 PubMed.
- Appelgrein C, Hosgood G, Drynan E & Nesbitt A (2020) Short-term outcome of adrenalectomy in dogs with adrenal gland tumours that did not receive pre-operative medical management. Aus Vet J 98 (9), 449-454 PubMed.
- Mayhew P D, Boston S E, Zwingenberger A L et al (2019) Perioperative morbidity and mortality in dogs with invasive adrenal neoplasms treated by adrenalectomy and cavotomy. Vet Surg 48 (5), 742-750 PubMed.
- Musser, M L, Taikowski K L, Johannes C M et al (2018) Retrospective evaluation of toceranib phosphate (Palladia®) use in the treatment of inoperable, metastatic, or recurrent canine pheochromocytomas: 5 dogs (2014–2017). BMC Vet Res 14 (1), 272 PubMed.
- Salesov E, Boretti F S, Sieber-Ruckstuhl N S et al (2015) Urinary and plasma catecholamines and metanephrines in dogs with pheochromocytoma, hypercortisolism, nonadrenal disease and in healthy dogs. J Vet Int Med 29 (2), 597-602 PubMed.
- Edmondson E F, Bright J M & Ehrhart (2014) Pathologic and cardiovascular characterization of pheochromocytoma-associated cardiomyopathy in dogs. Vet Path 52 (2), 338-343 PubMed.
- Bertazzolo W, Didier M, Gelain M E et al (2014) Accuracy of cytology in distinguishing adrenocortical tumors from pheochromocytoma in companion animals. Vet Clin Path 43 (3), 453-459 PubMed.
- Gostelow R, Bridger N & Syme H M (2013) Plasma-free metanephrine and free normetanephrine measurement for the diagnosis of pheochromocytoma in dogs. J Vet Int Med 27 (1), 83-90 PubMed.
- Quante S, Boretti F S, Kook P H et al (2010) Urinary catecholamine and metanephrine to creatinine ratios in dogs with hyperadrenocorticism or pheochromocytoma, and in healthy dogs. J Vet Int Med 24 (5), 1093-1097 PubMed.
- Louvet A, Lazard P & Denis B (2005) Phaeochromocytoma treated by en bloc resection including the suprarenal caudal vena cava in a dog. JSAP 46 (12), 591-596 PubMed.
- Schoeman J P & Stidworthy M F (2001) Budd-Chiari-like syndrome associated with an adrenal phaeochromocytoma in a dog. JSAP 42 (4), 191-194 PubMed.
- Rosenstein D S (2000) Diagnostic imaging in canine pheochromocytoma. Vet Rad Ultra 41 (6), 499-506 PubMed.
- Platt S R, Sheppard B J, Graham J et al (1998) Pheochromocytoma in the vertebral canal of two dogs. JAAHA 34 (5), 365-371 PubMed.
- Thuróczy J et al (1998) Multiple endocrine neoplasms in a dog - corticotrophic tumor, bilateral adrenocortical tumors, and pheochromocytoma. Vet Quart 20 (2), 56-61 VetMedResource.
- Barthez P Y, Marks S L, Woo J et al (1997) Pheochromocytoma in dogs - 61 cases (1984-1995). JVIM 11 (5), 272-278 PubMed.
- Bouayad H, Feeney D A, Caywood D D & Hayden D W (1987) Pheochromocytoma in dogs - 13 cases (1980-1985). JAVMA 191 (12), 1610-5 PubMed.
- Twedt D C & Wheeler S L (1984) Pheochromocytoma in the dog. Vet Clin N Am 14 (4), 767-82 PubMed.
Other resources
- Withrow S J & MacEwen E G (2020) Small Animal Clinical Oncology. 6th edn. W B Saunders, USA.